15D2100926 CLIA NUMBER - CARDINAL DERMATOLOGY, LLC

Laboratory Demographics

  • CLIA Code: 15D2100926
  • Facility Name: CARDINAL DERMATOLOGY, LLC
  • Facility Address: 4322 S LAFAYETTE BLVD
    SOUTH BEND, IN
    ZIP 46614
  • Facility Phone: 574 391-1111
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: LUIZ C. PANTALENA
  • NPI Number: 1124079330
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2100926
LAB Type Physician Office
Facility Name CARDINAL DERMATOLOGY, LLC
Street 4322 S LAFAYETTE BLVD
City SOUTH BEND
State IN
ZIP 46614
Phone 574 391-1111
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 2/17/2024
Certificate Expiration Date 2/16/2026
Facility Type Physician Office
Lab Director LUIZ C. PANTALENA

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