34D2292547 CLIA NUMBER - LIFE BLOOM LAB LLC

Laboratory Demographics

  • CLIA Code: 34D2292547
  • Facility Name: LIFE BLOOM LAB LLC
  • Facility Address: 710 N BROAD ST UNIT 13
    MOORESVILLE, NC
    ZIP 28115
  • Facility Phone: 704 665-8319
  • Facility Type: Other - DIAGNOSTICS LAB
  • Facility Type: Waiver
  • Lab Director: TONEKA WATSON
  • NPI Number: 1275315004
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 34D2292547
LAB Type Other - DIAGNOSTICS LAB
Facility Name LIFE BLOOM LAB LLC
Street 710 N BROAD ST UNIT 13
City MOORESVILLE
State NC
ZIP 28115
Phone 704 665-8319
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Other - DIAGNOSTICS LAB
Lab Director TONEKA WATSON

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