10D0881997 CLIA NUMBER - FATAH A WALLIZADA MD

Laboratory Demographics

  • CLIA Code: 10D0881997
  • Facility Name: FATAH A WALLIZADA MD
  • Facility Address: 2260 CASSAT AVE
    JACKSONVILLE, FL
    ZIP 32210
  • Facility Phone: 904 388-5832
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FATAH A. WALLIZADA MD
  • NPI Number: 1255351599
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0881997
LAB Type Physician Office
Facility Name FATAH A WALLIZADA MD
Street 2260 CASSAT AVE
City JACKSONVILLE
State FL
ZIP 32210
Phone 904 388-5832
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2024
Certificate Expiration Date 1/25/2026
Facility Type Physician Office
Lab Director FATAH A. WALLIZADA MD

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