16D2218040 CLIA NUMBER - REVIVE DERMATOLOGY CLINIC AND SPA

Laboratory Demographics

  • CLIA Code: 16D2218040
  • Facility Name: REVIVE DERMATOLOGY CLINIC AND SPA
  • Facility Address: 1850 SW PLAZA SHOPS LN, STE A
    ANKENY, IA
    ZIP 50023
  • Facility Phone: 515 965-5677
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEFANIE GATICA
  • NPI Number: 1205479888
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 16D2218040
LAB Type Physician Office
Facility Name REVIVE DERMATOLOGY CLINIC AND SPA
Street 1850 SW PLAZA SHOPS LN, STE A
City ANKENY
State IA
ZIP 50023
Phone 515 965-5677
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Physician Office
Lab Director STEFANIE GATICA

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