12D2302206 CLIA NUMBER - MANGO MEDICAL

Laboratory Demographics

  • CLIA Code: 12D2302206
  • Facility Name: MANGO MEDICAL
  • Facility Address: 64-1032 MAMALAHOA HWY, SUITE 306
    KAMUELA, HI
    ZIP 96743
  • Facility Phone: 808 769-5010
  • Facility Type: Other - CLINIC
  • Facility Type: Waiver
  • Lab Director: JOSHUA LESSARD-CHAUDOIN
  • NPI Number: 1376837997
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 12D2302206
LAB Type Other - CLINIC
Facility Name MANGO MEDICAL
Street 64-1032 MAMALAHOA HWY, SUITE 306
City KAMUELA
State HI
ZIP 96743
Phone 808 769-5010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2024
Certificate Expiration Date 4/4/2026
Facility Type Other - CLINIC
Lab Director JOSHUA LESSARD-CHAUDOIN

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