42D2260728 CLIA NUMBER - UNIVERSAL PRIMARY CARE & AESTHETICS, LLC

Laboratory Demographics

  • CLIA Code: 42D2260728
  • Facility Name: UNIVERSAL PRIMARY CARE & AESTHETICS, LLC
  • Facility Address: 105 CENTRAL AVENUE, SUITE 100 B
    GOOSE CREEK, SC
    ZIP 29445
  • Facility Phone: 843 557-9808
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. GUTEMBERGUE A. SANTOS
  • NPI Number: 1366078420
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 42D2260728
LAB Type Practitioner Other
Facility Name UNIVERSAL PRIMARY CARE & AESTHETICS, LLC
Street 105 CENTRAL AVENUE, SUITE 100 B
City GOOSE CREEK
State SC
ZIP 29445
Phone 843 557-9808
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2024
Certificate Expiration Date 5/22/2026
Facility Type Practitioner Other
Lab Director DR. GUTEMBERGUE A. SANTOS

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