19D2174922 CLIA NUMBER - BRAIN & PAIN CARE LLC

Laboratory Demographics

  • CLIA Code: 19D2174922
  • Facility Name: BRAIN & PAIN CARE LLC
  • Facility Address: 7600 FERN AVE, STE 700B
    SHREVEPORT, LA
    ZIP 71105
  • Facility Phone: 318 469-8517
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: GUSTAVO DE LEON
  • NPI Number: 1760025001
  • Taxonomy: 208VP0000X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D2174922
LAB Type Physician Office
Facility Name BRAIN & PAIN CARE LLC
Street 7600 FERN AVE, STE 700B
City SHREVEPORT
State LA
ZIP 71105
Phone 318 469-8517
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 11/9/2024
Certificate Expiration Date 11/8/2026
Facility Type Physician Office
Lab Director GUSTAVO DE LEON

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