10D2007220 CLIA NUMBER - PEDIATRIC KIDNEY CENTER OF SOUTH FLORIDA LLC

Laboratory Demographics

  • CLIA Code: 10D2007220
  • Facility Name: PEDIATRIC KIDNEY CENTER OF SOUTH FLORIDA LLC
  • Facility Address: 7800 SW 57TH AVENUE SUITE 305
    SOUTH MIAMI, FL
    ZIP 33143
  • Facility Phone: 305 856-7005
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FANNY GONZALEZ
  • NPI Number: 1144537077
  • Taxonomy: 2080P0214X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D2007220
LAB Type Physician Office
Facility Name PEDIATRIC KIDNEY CENTER OF SOUTH FLORIDA LLC
Street 7800 SW 57TH AVENUE SUITE 305
City SOUTH MIAMI
State FL
ZIP 33143
Phone 305 856-7005
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2024
Certificate Expiration Date 5/10/2026
Facility Type Physician Office
Lab Director FANNY GONZALEZ

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