40D2065112 CLIA NUMBER - CENTRO DE MEDICINA PRIMARIA DE VEGA ALTA

Laboratory Demographics

  • CLIA Code: 40D2065112
  • Facility Name: CENTRO DE MEDICINA PRIMARIA DE VEGA ALTA
  • Facility Address: CALLE LUIS MUNOZ RIVERA 3 3
    VEGA ALTA, PR
    ZIP 00692
  • Facility Phone: 787 883-0124
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. MILDALIAS DOMINGUEZ
  • NPI Number: 1386293199
  • Taxonomy: 2083P0901X - Preventive Medicine

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CLIA Record

Field Name Field Value
CLIA Number 40D2065112
LAB Type Rural Health Clinic
Facility Name CENTRO DE MEDICINA PRIMARIA DE VEGA ALTA
Street CALLE LUIS MUNOZ RIVERA 3 3
City VEGA ALTA
State PR
ZIP 00692
Phone 787 883-0124
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2025
Certificate Expiration Date 9/3/2027
Facility Type Rural Health Clinic
Lab Director DR. MILDALIAS DOMINGUEZ

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