10D2292648 CLIA NUMBER - JUPITER MEDICAL CENTER PHYSICIAN GROUP INC

Laboratory Demographics

  • CLIA Code: 10D2292648
  • Facility Name: JUPITER MEDICAL CENTER PHYSICIAN GROUP INC
  • Facility Address: 3250 PGA BLVD 2ND FLOOR
    PALM BEACH GARDENS, FL
    ZIP 33410
  • Facility Phone: 561 263-4361
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MORTEZA TAVAKOL
  • NPI Number: 1386196707
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2292648
LAB Type Physician Office
Facility Name JUPITER MEDICAL CENTER PHYSICIAN GROUP INC
Street 3250 PGA BLVD 2ND FLOOR
City PALM BEACH GARDENS
State FL
ZIP 33410
Phone 561 263-4361
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2023
Certificate Expiration Date 10/26/2025
Facility Type Physician Office
Lab Director MORTEZA TAVAKOL

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