10D2304983 CLIA NUMBER - PROACTIVE MD FL LLC

Laboratory Demographics

  • CLIA Code: 10D2304983
  • Facility Name: PROACTIVE MD FL LLC
  • Facility Address: 5245 41ST STREET
    VERO BEACH, FL
    ZIP 32966
  • Facility Phone: 864 501-0751
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: RAQUELLE MINISTRE
  • NPI Number: 1447901392
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2304983
LAB Type Practitioner Other
Facility Name PROACTIVE MD FL LLC
Street 5245 41ST STREET
City VERO BEACH
State FL
ZIP 32966
Phone 864 501-0751
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2024
Certificate Expiration Date 5/21/2026
Facility Type Practitioner Other
Lab Director RAQUELLE MINISTRE

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