23D1067076 CLIA NUMBER - MARIDEL A HERNANDEZ INTERNAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 23D1067076
  • Facility Name: MARIDEL A HERNANDEZ INTERNAL MEDICINE PC
  • Facility Address: 30140 HARPER AVENUE SUITE 300
    SAINT CLAIR SHORES, MI
    ZIP 48082
  • Facility Phone: 313 640-8400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIDEL A. HERNANDEZ
  • NPI Number: 1366526378
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 23D1067076
LAB Type Physician Office
Facility Name MARIDEL A HERNANDEZ INTERNAL MEDICINE PC
Street 30140 HARPER AVENUE SUITE 300
City SAINT CLAIR SHORES
State MI
ZIP 48082
Phone 313 640-8400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2025
Certificate Expiration Date 4/9/2027
Facility Type Physician Office
Lab Director MARIDEL A. HERNANDEZ

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