10D0663795 CLIA NUMBER - COASTAL PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 10D0663795
  • Facility Name: COASTAL PEDIATRICS LLC
  • Facility Address: 1275 W GRANADA BLVD - STE 3A
    ORMOND BEACH, FL
    ZIP 32174
  • Facility Phone: 386 672-1490
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEAN CLAUDE JEANTY MD
  • NPI Number: 1831199710
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D0663795
LAB Type Physician Office
Facility Name COASTAL PEDIATRICS LLC
Street 1275 W GRANADA BLVD - STE 3A
City ORMOND BEACH
State FL
ZIP 32174
Phone 386 672-1490
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 JEAN CLAUDE JEANTY MD

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