10D2017974 CLIA NUMBER - HARBOUR ISLAND PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 10D2017974
  • Facility Name: HARBOUR ISLAND PEDIATRICS LLC
  • Facility Address: 1301 PLANTATION ISLAND DR STE 105 B
    SAINT AUGUSTINE, FL
    ZIP 32080
  • Facility Phone: 904 461-8906
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: HOMERO V. SICANGCO
  • NPI Number: 1790086429
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D2017974
LAB Type Practitioner Other
Facility Name HARBOUR ISLAND PEDIATRICS LLC
Street 1301 PLANTATION ISLAND DR STE 105 B
City SAINT AUGUSTINE
State FL
ZIP 32080
Phone 904 461-8906
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2024
Certificate Expiration Date 12/21/2026
Facility Type Practitioner Other
Lab Director HOMERO V. SICANGCO

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