10D1081090 CLIA NUMBER - MAGNOLIA PEDIATRICS

Laboratory Demographics

  • CLIA Code: 10D1081090
  • Facility Name: MAGNOLIA PEDIATRICS
  • Facility Address: 1140 SW BASCOM NORRIS RD STE 104
    LAKE CITY, FL
    ZIP 32025
  • Facility Phone: 386 719-6500
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: STACEY S. CERVANTES
  • NPI Number: 1356513964
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D1081090
LAB Type Practitioner Other
Facility Name MAGNOLIA PEDIATRICS
Street 1140 SW BASCOM NORRIS RD STE 104
City LAKE CITY
State FL
ZIP 32025
Phone 386 719-6500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2024
Certificate Expiration Date 3/9/2026
Facility Type Practitioner Other
Lab Director STACEY S. CERVANTES

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This page was last updated on: 9/29/2025