05D2153739 CLIA NUMBER - VICTORVILLE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 05D2153739
  • Facility Name: VICTORVILLE PEDIATRICS
  • Facility Address: 15237 ELEVENTH STREET SUITE A
    VICTORVILLE, CA
    ZIP 92395
  • Facility Phone: 909 740-5531
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NAMITA P. MOHIDEEN
  • NPI Number: 1497249155
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D2153739
LAB Type Physician Office
Facility Name VICTORVILLE PEDIATRICS
Street 15237 ELEVENTH STREET SUITE A
City VICTORVILLE
State CA
ZIP 92395
Phone 909 740-5531
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/29/2024
Certificate Expiration Date 8/28/2026
Facility Type Physician Office
Lab Director NAMITA P. MOHIDEEN

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