10D0954077 CLIA NUMBER - WEST COAST PEDIATRICS

Laboratory Demographics

  • CLIA Code: 10D0954077
  • Facility Name: WEST COAST PEDIATRICS
  • Facility Address: 1414 59TH ST W
    BRADENTON, FL
    ZIP 34209
  • Facility Phone: 941 761-0663
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CONSTANCE CHARLES-LOGAN
  • NPI Number: 1710235569
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0954077
LAB Type Physician Office
Facility Name WEST COAST PEDIATRICS
Street 1414 59TH ST W
City BRADENTON
State FL
ZIP 34209
Phone 941 761-0663
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/17/2024
Certificate Expiration Date 11/16/2026
Facility Type Physician Office
Lab Director CONSTANCE CHARLES-LOGAN

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