05D0702921 CLIA NUMBER - COASTAL KIDS DBA SURFCITY PEDIATRICS

Laboratory Demographics

  • CLIA Code: 05D0702921
  • Facility Name: COASTAL KIDS DBA SURFCITY PEDIATRICS
  • Facility Address: 17742 BEACH BLVD STE 240
    HUNTINGTON BEACH, CA
    ZIP 92647
  • Facility Phone: 949 599-2434
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAULINE L. PEPEK
  • NPI Number: 1164723284
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D0702921
LAB Type Physician Office
Facility Name COASTAL KIDS DBA SURFCITY PEDIATRICS
Street 17742 BEACH BLVD STE 240
City HUNTINGTON BEACH
State CA
ZIP 92647
Phone 949 599-2434
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director PAULINE L. PEPEK

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