40D2300266 CLIA NUMBER - CONSOLIDATED MEDICAL PLAZA DERMATOLOGIA BORINQUEN AXIS CLINICALS

Laboratory Demographics

  • CLIA Code: 40D2300266
  • Facility Name: CONSOLIDATED MEDICAL PLAZA DERMATOLOGIA BORINQUEN AXIS CLINICALS
  • Facility Address: 201 AVENIDA JOSE GAUTIER BENITEZ OFFICE 405 A
    CAGUAS, PR
    ZIP 00725
  • Facility Phone: 701 866-3026
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. TANIA GONZALEZ-SANTIAGO
  • NPI Number: 1679542393
  • Taxonomy: 261QR0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 40D2300266
LAB Type Physician Office
Facility Name CONSOLIDATED MEDICAL PLAZA DERMATOLOGIA BORINQUEN AXIS CLINICALS
Street 201 AVENIDA JOSE GAUTIER BENITEZ OFFICE 405 A
City CAGUAS
State PR
ZIP 00725
Phone 701 866-3026
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2024
Certificate Expiration Date 3/5/2026
Facility Type Physician Office
Lab Director DR. TANIA GONZALEZ-SANTIAGO

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