10D1078845 CLIA NUMBER - COCONUT CREEK PEDIATRICS

Laboratory Demographics

CLIA Number: 10D1078845

Facility Name: COCONUT CREEK PEDIATRICS

Facility Address:
4400 W SAMPLE RD STE 122
COCONUT CREEK, FL
ZIP 33073
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Facility Phone Number: 954 978-6130

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1649441981

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	10D1078845
LAB Type	Physician Office
Facility Name	COCONUT CREEK PEDIATRICS
Street	4400 W SAMPLE RD STE 122
City	COCONUT CREEK
State	FL
ZIP	33073
Phone	954 978-6130
CertificateType	4
CertificateEffectiveDate	11/12/2023
CertificateExpirationDate	11/11/2025
FacilityType	Waiver

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