21D2138145 CLIA NUMBER - COSMETIC SURGERY FACILITY LLC

Laboratory Demographics

  • CLIA Code: 21D2138145
  • Facility Name: COSMETIC SURGERY FACILITY LLC
  • Facility Address: 1300 BELLONA AVENUE SUITE C
    LUTHERVILLE, MD
    ZIP 21093
  • Facility Phone: 410 494-8100
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RICARDO L. RODRIGUEZ MD
  • NPI Number: 1578763199
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2138145
LAB Type Ambulatory Surgery Center
Facility Name COSMETIC SURGERY FACILITY LLC
Street 1300 BELLONA AVENUE SUITE C
City LUTHERVILLE
State MD
ZIP 21093
Phone 410 494-8100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2025
Certificate Expiration Date 10/10/2027
Facility Type Ambulatory Surgery Center
Lab Director RICARDO L. RODRIGUEZ MD

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