10D2295026 CLIA NUMBER - UNIVIDA MEDICAL CENTER LLC

Laboratory Demographics

CLIA Number: 10D2295026

Facility Name: UNIVIDA MEDICAL CENTER LLC

Facility Address:
61 GRAND CANAL DR, STE 202
MIAMI, FL
ZIP 33144
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Facility Phone Number: 305 563-2189

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487321774

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	10D2295026
LAB Type	Physician Office
Facility Name	UNIVIDA MEDICAL CENTER LLC
Street	61 GRAND CANAL DR, STE 202
City	MIAMI
State	FL
ZIP	33144
Phone	305 563-2189
CertificateType	4
CertificateEffectiveDate	12/5/2023
CertificateExpirationDate	12/4/2025
FacilityType	Waiver

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