03D2269060 CLIA NUMBER - PINE PARK HEALTH

Laboratory Demographics

  • CLIA Code: 03D2269060
  • Facility Name: PINE PARK HEALTH
  • Facility Address: 19303 N NEW TRADITION RD
    SUN CITY WEST, AZ
    ZIP 85375
  • Facility Phone: 510 929-1400
  • Facility Type: Other - TESTING IN ALF
  • Facility Type: Waiver
  • Lab Director: CANNON M. KENDALL
  • NPI Number: 1346879848
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2269060
LAB Type Other - TESTING IN ALF
Facility Name PINE PARK HEALTH
Street 19303 N NEW TRADITION RD
City SUN CITY WEST
State AZ
ZIP 85375
Phone 510 929-1400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2024
Certificate Expiration Date 9/19/2026
Facility Type Other - TESTING IN ALF
Lab Director CANNON M. KENDALL

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