10D2268347 CLIA NUMBER - PRESTIGE HEALTH AND WELLNESS LLC

Laboratory Demographics

CLIA Number: 10D2268347

Facility Name: PRESTIGE HEALTH AND WELLNESS LLC

Facility Address:
10013 WATER WORKS LANE
RIVERVIEW, FL
ZIP 33578
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Facility Phone Number: 813 252-0171

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811650831

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2268347
LAB Type	Physician Office
Facility Name	PRESTIGE HEALTH AND WELLNESS LLC
Street	10013 WATER WORKS LANE
City	RIVERVIEW
State	FL
ZIP	33578
Phone	813 252-0171
CertificateType	4
CertificateEffectiveDate	9/9/2022
CertificateExpirationDate	9/8/2024
FacilityType	Waiver

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