10D1096774 CLIA NUMBER - DAVENPORT PEDIATARICS CLERMONT PA

Laboratory Demographics

CLIA Number: 10D1096774

Facility Name: DAVENPORT PEDIATARICS CLERMONT PA

Facility Address:
1528 SUNRISE PLAZA DR STE 1
CLERMONT, FL
ZIP 34714
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Facility Phone Number: 352 394-7728

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700021508

Taxonomy: 2080A0000X - Pediatrics
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

CLIA Record

Field Name	Field Value
CLIA Number	10D1096774
LAB Type	Physician Office
Facility Name	DAVENPORT PEDIATARICS CLERMONT PA
Street	1528 SUNRISE PLAZA DR STE 1
City	CLERMONT
State	FL
ZIP	34714
Phone	352 394-7728
CertificateType	4
CertificateEffectiveDate	3/11/2023
CertificateExpirationDate	3/10/2025
FacilityType	Waiver

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