10D2062454 CLIA NUMBER - DIVAKER PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 10D2062454
  • Facility Name: DIVAKER PEDIATRICS LLC
  • Facility Address: 6551 N ORANGE BLOSSOM TRL
    MOUNT DORA, FL
    ZIP 32757
  • Facility Phone: 407 615-5005
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SAMUEL DIVAKER
  • NPI Number: 1518302835
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D2062454
LAB Type Physician Office
Facility Name DIVAKER PEDIATRICS LLC
Street 6551 N ORANGE BLOSSOM TRL
City MOUNT DORA
State FL
ZIP 32757
Phone 407 615-5005
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2025
Certificate Expiration Date 7/16/2027
Facility Type Physician Office
Lab Director SAMUEL DIVAKER

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