12D2311161 CLIA NUMBER - MINDWAVE MEDICINE

Laboratory Demographics

  • CLIA Code: 12D2311161
  • Facility Name: MINDWAVE MEDICINE
  • Facility Address: 100 KAHELU AVE, STE 100
    MILILANI, HI
    ZIP 96789
  • Facility Phone: 727 418-8466
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CHELSEA A. RORER
  • NPI Number: 1760290787
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 12D2311161
LAB Type Practitioner Other
Facility Name MINDWAVE MEDICINE
Street 100 KAHELU AVE, STE 100
City MILILANI
State HI
ZIP 96789
Phone 727 418-8466
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Practitioner Other
Lab Director CHELSEA A. RORER

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