10D2286707 CLIA NUMBER - CULINARY MD, INC

Laboratory Demographics

CLIA Number: 10D2286707

Facility Name: CULINARY MD, INC

Facility Address:
10450 SAN JOSE BLVD UNIT B
JACKSONVILLE, FL
ZIP 32257
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Facility Phone Number: 904 385-8296

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1093439820

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2286707
LAB Type	Physician Office
Facility Name	CULINARY MD, INC
Street	10450 SAN JOSE BLVD UNIT B
City	JACKSONVILLE
State	FL
ZIP	32257
Phone	904 385-8296
CertificateType	4
CertificateEffectiveDate	8/2/2023
CertificateExpirationDate	8/1/2025
FacilityType	Waiver

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