10D2264081 CLIA NUMBER - IC PROFESSIONAL SERVICES INC

Laboratory Demographics

  • CLIA Code: 10D2264081
  • Facility Name: IC PROFESSIONAL SERVICES INC
  • Facility Address: 4995 NW 72 AVE S #201
    MIAMI, FL
    ZIP 33166
  • Facility Phone: 786 452-8963
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ILIANA CAMEJO
  • NPI Number: 1841939758
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2264081
LAB Type Practitioner Other
Facility Name IC PROFESSIONAL SERVICES INC
Street 4995 NW 72 AVE S #201
City MIAMI
State FL
ZIP 33166
Phone 786 452-8963
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2024
Certificate Expiration Date 7/10/2026
Facility Type Practitioner Other
Lab Director ILIANA CAMEJO

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