10D0980569 CLIA NUMBER - LONGWOOD PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 10D0980569
  • Facility Name: LONGWOOD PEDIATRICS LLC
  • Facility Address: 1400 WEST STATE ROAD 434 SUITE 1010
    LONGWOOD, FL
    ZIP 32750
  • Facility Phone: 407 644-9970
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JAGDISH AMBWANI
  • NPI Number: 1467891531
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0980569
LAB Type Physician Office
Facility Name LONGWOOD PEDIATRICS LLC
Street 1400 WEST STATE ROAD 434 SUITE 1010
City LONGWOOD
State FL
ZIP 32750
Phone 407 644-9970
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2024
Certificate Expiration Date 11/27/2026
Facility Type Physician Office
Lab Director DR. JAGDISH AMBWANI

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This page was last updated on: 6/4/2025