45D2302792 CLIA NUMBER - VYTALUS MEDICAL GROUP - BALMORAL

Laboratory Demographics

  • CLIA Code: 45D2302792
  • Facility Name: VYTALUS MEDICAL GROUP - BALMORAL
  • Facility Address: 15720 WOODLAND HILLS DR, STE 600
    HUMBLE, TX
    ZIP 77346
  • Facility Phone: 281 359-3223
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARTIN BASALDUA
  • NPI Number: 1053631275
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2302792
LAB Type Physician Office
Facility Name VYTALUS MEDICAL GROUP - BALMORAL
Street 15720 WOODLAND HILLS DR, STE 600
City HUMBLE
State TX
ZIP 77346
Phone 281 359-3223
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2024
Certificate Expiration Date 4/15/2026
Facility Type Physician Office
Lab Director MARTIN BASALDUA

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