45D2191410 CLIA NUMBER - FORMULA WELLNESS PARK CITIES

Laboratory Demographics

  • CLIA Code: 45D2191410
  • Facility Name: FORMULA WELLNESS PARK CITIES
  • Facility Address: 4342 LOVERS LN
    DALLAS, TX
    ZIP 75225
  • Facility Phone: 214 931-9443
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRIAN RUDMAN
  • NPI Number: 1346608536
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2191410
LAB Type Physician Office
Facility Name FORMULA WELLNESS PARK CITIES
Street 4342 LOVERS LN
City DALLAS
State TX
ZIP 75225
Phone 214 931-9443
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2025
Certificate Expiration Date 6/28/2027
Facility Type Physician Office
Lab Director BRIAN RUDMAN

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