10D1038491 CLIA NUMBER - MOSOLF PEDIATRICS PA

Laboratory Demographics

CLIA Number: 10D1038491

Facility Name: MOSOLF PEDIATRICS PA

Facility Address:
14197 SPARTINA CT
JACKSONVILLE, FL
ZIP 32224
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Facility Phone Number: 904 249-3858

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144357690

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1038491
LAB Type	Physician Office
Facility Name	MOSOLF PEDIATRICS PA
Street	14197 SPARTINA CT
City	JACKSONVILLE
State	FL
ZIP	32224
Phone	904 249-3858
CertificateType	4
CertificateEffectiveDate	3/21/2023
CertificateExpirationDate	3/20/2025
FacilityType	Waiver

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