45D2264432 CLIA NUMBER - DREAMLUXXE MEDSPA & WELLNESS DBA ELITE ON MAIN

Laboratory Demographics

  • CLIA Code: 45D2264432
  • Facility Name: DREAMLUXXE MEDSPA & WELLNESS DBA ELITE ON MAIN
  • Facility Address: 5103 MAGNA CARTA BLVD SUITE 150
    GRAND PRAIRIE, TX
    ZIP 75052
  • Facility Phone: 972 369-3464
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: NWONUMAH CHINWEM
  • NPI Number: 1568096816
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2264432
LAB Type Practitioner Other
Facility Name DREAMLUXXE MEDSPA & WELLNESS DBA ELITE ON MAIN
Street 5103 MAGNA CARTA BLVD SUITE 150
City GRAND PRAIRIE
State TX
ZIP 75052
Phone 972 369-3464
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2024
Certificate Expiration Date 7/13/2026
Facility Type Practitioner Other
Lab Director NWONUMAH CHINWEM

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