10D2254916 CLIA NUMBER - FOREVER YOUNG DIAGNOSTICS

Laboratory Demographics

CLIA Number: 10D2254916

Facility Name: FOREVER YOUNG DIAGNOSTICS

Facility Address:
110 LITHIA PINECREST RD - STE C
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 857-8556

Facility Type: Other - DIAGNOSTIC LAB SERVICE

Certificate Type: Waiver

NPI Number: 1366194649

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2254916
LAB Type	Other - DIAGNOSTIC LAB SERVICE
Facility Name	FOREVER YOUNG DIAGNOSTICS
Street	110 LITHIA PINECREST RD - STE C
City	BRANDON
State	FL
ZIP	33511
Phone	813 857-8556
CertificateType	4
CertificateEffectiveDate	3/9/2024
CertificateExpirationDate	3/8/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024