10D2320977 CLIA NUMBER - COASTAL INFUSION LLC

Laboratory Demographics

  • CLIA Code: 10D2320977
  • Facility Name: COASTAL INFUSION LLC
  • Facility Address: 5511 S CONGRESS AVENUE, SUITE 115
    ATLANTIS, FL
    ZIP 33462
  • Facility Phone: 954 361-1000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHNATHAN R. GOTTLEIB
  • NPI Number: 1366200594
  • Taxonomy: 261QI0500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2320977
LAB Type Physician Office
Facility Name COASTAL INFUSION LLC
Street 5511 S CONGRESS AVENUE, SUITE 115
City ATLANTIS
State FL
ZIP 33462
Phone 954 361-1000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2025
Certificate Expiration Date 3/26/2027
Facility Type Physician Office
Lab Director JOHNATHAN R. GOTTLEIB

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