10D2260538 CLIA NUMBER - LIBERTY PHYSICIANS ASSOCIATES

Laboratory Demographics

CLIA Number: 10D2260538

Facility Name: LIBERTY PHYSICIANS ASSOCIATES

Facility Address:
515 W SR 434 SUITE 306
LONGWOOD, FL
ZIP 32750
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Facility Phone Number: 321 972-8905

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1376181446

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2260538
LAB Type	Physician Office
Facility Name	LIBERTY PHYSICIANS ASSOCIATES
Street	515 W SR 434 SUITE 306
City	LONGWOOD
State	FL
ZIP	32750
Phone	321 972-8905
CertificateType	4
CertificateEffectiveDate	5/19/2022
CertificateExpirationDate	5/18/2024
FacilityType	Waiver

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