33D1047084 CLIA NUMBER - GODWIN MEDICAL PC LUISA PEREZ MD

Laboratory Demographics

CLIA Number: 33D1047084

Facility Name: GODWIN MEDICAL PC LUISA PEREZ MD

Facility Address:
231 WEST 231ST STREET, STE 1B
BRONX, NY
ZIP 10463
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Facility Phone Number: 347 587-4020

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1679749808

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D1047084
LAB Type	Physician Office
Facility Name	GODWIN MEDICAL PC LUISA PEREZ MD
Street	231 WEST 231ST STREET, STE 1B
City	BRONX
State	NY
ZIP	10463
Phone	347 587-4020
CertificateType	4
CertificateEffectiveDate	10/26/2023
CertificateExpirationDate	10/25/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024