49D2310566 CLIA NUMBER - MANGO WELLNESS

Laboratory Demographics

  • CLIA Code: 49D2310566
  • Facility Name: MANGO WELLNESS
  • Facility Address: 11166 FAIRFAX BLVD, SUITE 500 F46
    FAIRFAX, VA
    ZIP 22030
  • Facility Phone: 703 686-5833
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: HAILEY H. JUN
  • NPI Number: 1992535835
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 49D2310566
LAB Type Practitioner Other
Facility Name MANGO WELLNESS
Street 11166 FAIRFAX BLVD, SUITE 500 F46
City FAIRFAX
State VA
ZIP 22030
Phone 703 686-5833
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2024
Certificate Expiration Date 9/4/2026
Facility Type Practitioner Other
Lab Director HAILEY H. JUN

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