05D2051703 CLIA NUMBER - COASTAL KIDS DBA SURFSIDE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 05D2051703
  • Facility Name: COASTAL KIDS DBA SURFSIDE PEDIATRICS
  • Facility Address: 2601 E MAIN ST, STE 200
    VENTURA, CA
    ZIP 93003
  • Facility Phone: 714 842-0444
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEVIN WHITE
  • NPI Number: 1952495921
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D2051703
LAB Type Physician Office
Facility Name COASTAL KIDS DBA SURFSIDE PEDIATRICS
Street 2601 E MAIN ST, STE 200
City VENTURA
State CA
ZIP 93003
Phone 714 842-0444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/26/2024
Certificate Expiration Date 12/25/2026
Facility Type Physician Office
Lab Director KEVIN WHITE

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