10D2301708 CLIA NUMBER - UNIVERSITY OF CENTRAL FLORIDA BOARD OF TRUSTEES

Laboratory Demographics

CLIA Number: 10D2301708

Facility Name: UNIVERSITY OF CENTRAL FLORIDA BOARD OF TRUSTEES

Facility Address:
12805 PEGASUS DR, HS1, ROOM 365C
ORLANDO, FL
ZIP 32816
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Facility Phone Number: 407 823-6761

Facility Type: Other - COMMUNITY WELLNESS PROG

Certificate Type: Waiver

NPI Number: 1386176097

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2301708
LAB Type	Other - COMMUNITY WELLNESS PROG
Facility Name	UNIVERSITY OF CENTRAL FLORIDA BOARD OF TRUSTEES
Street	12805 PEGASUS DR, HS1, ROOM 365C
City	ORLANDO
State	FL
ZIP	32816
Phone	407 823-6761
CertificateType	4
CertificateEffectiveDate	3/29/2024
CertificateExpirationDate	3/28/2026
FacilityType	Waiver

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