36D2211963 CLIA NUMBER - ETERNAL IMPRESSIONS, LLC DBA JIVA MED SPA

Laboratory Demographics

  • CLIA Code: 36D2211963
  • Facility Name: ETERNAL IMPRESSIONS, LLC DBA JIVA MED SPA
  • Facility Address: 1127 DUBLIN ROAD
    COLUMBUS, OH
    ZIP 43215
  • Facility Phone: 614 421-7546
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAKESH A. NANDA
  • NPI Number: 1831578350
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2211963
LAB Type Physician Office
Facility Name ETERNAL IMPRESSIONS, LLC DBA JIVA MED SPA
Street 1127 DUBLIN ROAD
City COLUMBUS
State OH
ZIP 43215
Phone 614 421-7546
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/2/2025
Certificate Expiration Date 2/1/2027
Facility Type Physician Office
Lab Director RAKESH A. NANDA

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