10D0931750 CLIA NUMBER - PEDIATRICS AND ADOLESCENT MEDICINE

Laboratory Demographics

  • CLIA Code: 10D0931750
  • Facility Name: PEDIATRICS AND ADOLESCENT MEDICINE
  • Facility Address: 2051 PROFESSIONAL CENTER DR
    ORANGE PARK, FL
    ZIP 32073
  • Facility Phone: 904 276-0005
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KHALIL A. WALLIZADA
  • NPI Number: 1053360669
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0931750
LAB Type Physician Office
Facility Name PEDIATRICS AND ADOLESCENT MEDICINE
Street 2051 PROFESSIONAL CENTER DR
City ORANGE PARK
State FL
ZIP 32073
Phone 904 276-0005
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2025
Certificate Expiration Date 8/4/2027
Facility Type Physician Office
Lab Director KHALIL A. WALLIZADA

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