10D1100078 CLIA NUMBER - SUNRISE PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 10D1100078
  • Facility Name: SUNRISE PEDIATRICS LLC
  • Facility Address: 25103 HWY 27
    LAKE WALES, FL
    ZIP 33859
  • Facility Phone: 863 734-0344
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAGDEEP S. PRUTHI
  • NPI Number: 1891939989
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D1100078
LAB Type Physician Office
Facility Name SUNRISE PEDIATRICS LLC
Street 25103 HWY 27
City LAKE WALES
State FL
ZIP 33859
Phone 863 734-0344
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/29/2025
Certificate Expiration Date 5/28/2027
Facility Type Physician Office
Lab Director JAGDEEP S. PRUTHI

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