CLIA lab
CLIA 45D2295921: Revitalize Wellness Clinic, LLC
Hollywood Park, TX. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 45D2295921 belongs to Revitalize Wellness Clinic, LLC in Hollywood Park, TX.
Certificate of Waiver, effective December 19, 2025, expires December 18, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- December 19, 2025
- Certificate expiration
- December 18, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- December 19, 2023
- Facility type
- Other
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 45D2295921
- Lab name
- Revitalize Wellness Clinic, LLC
- Address
- 15909-16111 San Pedro Avenue, Suite 201, Hollywood Park, TX 78232
- Phone
- (210) 459-1475
- Fax
- (210) 767-9851
Annual test volume the lab reported
- Waived tests
- 500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Hollywood Park, TX
Related
Questions
What is the CLIA number for Revitalize Wellness Clinic, LLC in Hollywood Park?
45D2295921, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Revitalize Wellness Clinic, LLC hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 45D2295921 expire?
The CMS file lists December 18, 2027 as the certificate expiration date; the certificate took effect December 19, 2025.