10D0677462 CLIA NUMBER - ONE SOURCE PEDIATRICS PA

Laboratory Demographics

CLIA Number: 10D0677462

Facility Name: ONE SOURCE PEDIATRICS PA

Facility Address:
1625 NORTH COMMERCE PARKWAY SUITE 205
WESTON, FL
ZIP 33326
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Facility Phone Number: 354 474-4888

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346266962

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0677462
LAB Type	Physician Office
Facility Name	ONE SOURCE PEDIATRICS PA
Street	1625 NORTH COMMERCE PARKWAY SUITE 205
City	WESTON
State	FL
ZIP	33326
Phone	354 474-4888
CertificateType	4
CertificateEffectiveDate	9/29/2022
CertificateExpirationDate	9/28/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024