10D2312377 CLIA NUMBER - VASCULAR AND EMBOLIZATION SPECIALISTS, PLLC

Laboratory Demographics

  • CLIA Code: 10D2312377
  • Facility Name: VASCULAR AND EMBOLIZATION SPECIALISTS, PLLC
  • Facility Address: 2300 FL-524 SUITE 106
    COCOA, FL
    ZIP 32926
  • Facility Phone: 321 468-2300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEREK MITTLEIDER
  • NPI Number: 1629846910
  • Taxonomy: 2085R0204X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 10D2312377
LAB Type Physician Office
Facility Name VASCULAR AND EMBOLIZATION SPECIALISTS, PLLC
Street 2300 FL-524 SUITE 106
City COCOA
State FL
ZIP 32926
Phone 321 468-2300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/10/2024
Certificate Expiration Date 10/9/2026
Facility Type Physician Office
Lab Director DEREK MITTLEIDER

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