10D2270077 CLIA NUMBER - TOTAL BODY AESTHETICS AND MEDICAL CARE

Laboratory Demographics

CLIA Number: 10D2270077

Facility Name: TOTAL BODY AESTHETICS AND MEDICAL CARE

Facility Address:
595 W CHURCH ST, SUITE F
ORLANDO, FL
ZIP 32805
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Facility Phone Number: 407 219-1617

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1831810530

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2270077
LAB Type	Practitioner Other
Facility Name	TOTAL BODY AESTHETICS AND MEDICAL CARE
Street	595 W CHURCH ST, SUITE F
City	ORLANDO
State	FL
ZIP	32805
Phone	407 219-1617
CertificateType	4
CertificateEffectiveDate	10/7/2022
CertificateExpirationDate	10/6/2024
FacilityType	Waiver

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