10D2301686 CLIA NUMBER - MEDSPA & PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 10D2301686
  • Facility Name: MEDSPA & PRIMARY CARE LLC
  • Facility Address: 825 E COWBOY WAY SUITE 106
    LABELLE, FL
    ZIP 33935
  • Facility Phone: 863 230-8163
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: AHITZA CARRAZANA ESTRADA
  • NPI Number: 1548021314
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2301686
LAB Type Practitioner Other
Facility Name MEDSPA & PRIMARY CARE LLC
Street 825 E COWBOY WAY SUITE 106
City LABELLE
State FL
ZIP 33935
Phone 863 230-8163
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2024
Certificate Expiration Date 3/28/2026
Facility Type Practitioner Other
Lab Director AHITZA CARRAZANA ESTRADA

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