10D2326711 CLIA NUMBER - AGELESS VITALITY CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D2326711
  • Facility Name: AGELESS VITALITY CENTER LLC
  • Facility Address: 4730 N HABANA AVE, SUITE 101
    TAMPA, FL
    ZIP 33614
  • Facility Phone: 813 955-4289
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LUIS MEJIA-GARCIA
  • NPI Number: 1649008491
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2326711
LAB Type Physician Office
Facility Name AGELESS VITALITY CENTER LLC
Street 4730 N HABANA AVE, SUITE 101
City TAMPA
State FL
ZIP 33614
Phone 813 955-4289
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2025
Certificate Expiration Date 7/8/2027
Facility Type Physician Office
Lab Director LUIS MEJIA-GARCIA

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