10D1055613 CLIA NUMBER - PORT ORANGE PEDIATRICS PA

Laboratory Demographics

  • CLIA Code: 10D1055613
  • Facility Name: PORT ORANGE PEDIATRICS PA
  • Facility Address: 1728 DUNLAWTON AVE STE 1
    PORT ORANGE, FL
    ZIP 32127
  • Facility Phone: (386) 322-5390
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUBEN J. LOPEZ MD
  • NPI Number: 1902084064
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D1055613
LAB Type Physician Office
Facility Name PORT ORANGE PEDIATRICS PA
Street 1728 DUNLAWTON AVE STE 1
City PORT ORANGE
State FL
ZIP 32127
Phone 3863225390
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/22/2024
Certificate Expiration Date 6/21/2026
Facility Type Physician Office
Lab Director RUBEN J. LOPEZ MD

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This page was last updated on: 5/18/2026