10D2318749 CLIA NUMBER - ROSEBERRY INTEGRATIVE CARE LLC

Laboratory Demographics

  • CLIA Code: 10D2318749
  • Facility Name: ROSEBERRY INTEGRATIVE CARE LLC
  • Facility Address: 4210 VALLEY RIDGE BLVD STE 140
    PONTE VEDRA, FL
    ZIP 32081
  • Facility Phone: 904 800-5701
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BEVERLY J. ROSEBERRY
  • NPI Number: 1992523344
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2318749
LAB Type Physician Office
Facility Name ROSEBERRY INTEGRATIVE CARE LLC
Street 4210 VALLEY RIDGE BLVD STE 140
City PONTE VEDRA
State FL
ZIP 32081
Phone 904 800-5701
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/18/2025
Certificate Expiration Date 2/17/2027
Facility Type Physician Office
Lab Director BEVERLY J. ROSEBERRY

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