49D2126672 CLIA NUMBER - WELL-CARE CORP

Laboratory Demographics

  • CLIA Code: 49D2126672
  • Facility Name: WELL-CARE CORP
  • Facility Address: 13885 HEDGEWOOD DRIVE UNIT 237 BLDG 2
    WOODBRIDGE, VA
    ZIP 22193
  • Facility Phone: 571 594-9110
  • Facility Type: Other - FAMILY NURSE PRACTITIONER
  • Facility Type: Waiver
  • Lab Director: CARLOS FAGBENRO
  • NPI Number: 1952853061
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 49D2126672
LAB Type Other - FAMILY NURSE PRACTITIONER
Facility Name WELL-CARE CORP
Street 13885 HEDGEWOOD DRIVE UNIT 237 BLDG 2
City WOODBRIDGE
State VA
ZIP 22193
Phone 571 594-9110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2025
Certificate Expiration Date 3/1/2027
Facility Type Other - FAMILY NURSE PRACTITIONER
Lab Director CARLOS FAGBENRO

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