10D2279940 CLIA NUMBER - PALM WELLNESS CENTER LLC

Laboratory Demographics

CLIA Number: 10D2279940

Facility Name: PALM WELLNESS CENTER LLC

Facility Address:
1004 W LINEBAUGH AVE SUITE A
TAMPA, FL
ZIP 33612
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Facility Phone Number: 813 443-5370

Facility Type: Other - WELLNESS CENTER

Certificate Type: Waiver

NPI Number: 1255736831

Taxonomy: 261QR0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2279940
LAB Type	Other - WELLNESS CENTER
Facility Name	PALM WELLNESS CENTER LLC
Street	1004 W LINEBAUGH AVE SUITE A
City	TAMPA
State	FL
ZIP	33612
Phone	813 443-5370
CertificateType	4
CertificateEffectiveDate	4/11/2023
CertificateExpirationDate	4/10/2025
FacilityType	Waiver

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