45D2069225 CLIA NUMBER - LAKESIDE LIFE CENTER

Laboratory Demographics

  • CLIA Code: 45D2069225
  • Facility Name: LAKESIDE LIFE CENTER
  • Facility Address: 4100 FAIRWAY DRIVE, SUITE 200
    CARROLLTON, TX
    ZIP 75010
  • Facility Phone: 972 221-1741
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NISHENDU VASAVADA
  • NPI Number: 1700901022
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 45D2069225
LAB Type Physician Office
Facility Name LAKESIDE LIFE CENTER
Street 4100 FAIRWAY DRIVE, SUITE 200
City CARROLLTON
State TX
ZIP 75010
Phone 972 221-1741
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2023
Certificate Expiration Date 11/19/2025
Facility Type Physician Office
Lab Director NISHENDU VASAVADA

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