10D0267384 CLIA NUMBER - ANCIENT CITY PEDIATRICS

Laboratory Demographics

  • CLIA Code: 10D0267384
  • Facility Name: ANCIENT CITY PEDIATRICS
  • Facility Address: 1301 PLANTATION ISLAND DR S STE 404
    SAINT AUGUSTINE, FL
    ZIP 32080
  • Facility Phone: 904 461-1560
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MIGUEL A. MAS JR
  • NPI Number: 1053598292
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0267384
LAB Type Physician Office
Facility Name ANCIENT CITY PEDIATRICS
Street 1301 PLANTATION ISLAND DR S STE 404
City SAINT AUGUSTINE
State FL
ZIP 32080
Phone 904 461-1560
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/26/2024
Certificate Expiration Date 7/25/2026
Facility Type Physician Office
Lab Director MIGUEL A. MAS JR

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