10D1093123 CLIA NUMBER - MY PEDIATRICIAN PA

Laboratory Demographics

  • CLIA Code: 10D1093123
  • Facility Name: MY PEDIATRICIAN PA
  • Facility Address: 1037 PROFESSIONAL PARK DR
    BRANDON, FL
    ZIP 33511
  • Facility Phone: 813 684-5659
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALICIA M. ONG MD
  • NPI Number: 1619128675
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D1093123
LAB Type Physician Office
Facility Name MY PEDIATRICIAN PA
Street 1037 PROFESSIONAL PARK DR
City BRANDON
State FL
ZIP 33511
Phone 813 684-5659
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Physician Office
Lab Director ALICIA M. ONG MD

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