10D2309099 CLIA NUMBER - WELLNESS360 PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 10D2309099
  • Facility Name: WELLNESS360 PRIMARY CARE
  • Facility Address: 1700 SE HILLMOOR DRIVE SUITE 305
    PORT SAINT LUCIE, FL
    ZIP 34952
  • Facility Phone: 772 446-3403
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: YOHANNA DENO
  • NPI Number: 1154172773
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2309099
LAB Type Physician Office
Facility Name WELLNESS360 PRIMARY CARE
Street 1700 SE HILLMOOR DRIVE SUITE 305
City PORT SAINT LUCIE
State FL
ZIP 34952
Phone 772 446-3403
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2024
Certificate Expiration Date 8/8/2026
Facility Type Physician Office
Lab Director YOHANNA DENO

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