10D2257252 CLIA NUMBER - MANGO WELLNESS, LLC

Laboratory Demographics

  • CLIA Code: 10D2257252
  • Facility Name: MANGO WELLNESS, LLC
  • Facility Address: 2801 13TH ST
    SAINT CLOUD, FL
    ZIP 34769
  • Facility Phone: 407 593-2958
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MIGUEL DAVILA
  • NPI Number: 1912570987
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2257252
LAB Type Physician Office
Facility Name MANGO WELLNESS, LLC
Street 2801 13TH ST
City SAINT CLOUD
State FL
ZIP 34769
Phone 407 593-2958
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2024
Certificate Expiration Date 3/31/2026
Facility Type Physician Office
Lab Director MIGUEL DAVILA

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This page was last updated on: 9/29/2025