10D0964322 CLIA NUMBER - PEDIATRIC CARE CENTER INC

Laboratory Demographics

CLIA Number: 10D0964322

Facility Name: PEDIATRIC CARE CENTER INC

Facility Address:
2135 S CONGRESS AVE BLDG 2 SUITE C
WEST PALM BEACH, FL
ZIP 33406
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Facility Phone Number: 561 432-1822

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1396095998

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0964322
LAB Type	Physician Office
Facility Name	PEDIATRIC CARE CENTER INC
Street	2135 S CONGRESS AVE BLDG 2 SUITE C
City	WEST PALM BEACH
State	FL
ZIP	33406
Phone	561 432-1822
CertificateType	4
CertificateEffectiveDate	8/23/2023
CertificateExpirationDate	8/22/2025
FacilityType	Waiver

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