10D2072291 CLIA NUMBER - PEDIATRICA OF ST AUGUSTINE SOUTH

Laboratory Demographics

  • CLIA Code: 10D2072291
  • Facility Name: PEDIATRICA OF ST AUGUSTINE SOUTH
  • Facility Address: 2676 US -1
    SAINT AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 797-2121
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALIYA M. YASIN
  • NPI Number: 1457565947
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 10D2072291
LAB Type Physician Office
Facility Name PEDIATRICA OF ST AUGUSTINE SOUTH
Street 2676 US -1
City SAINT AUGUSTINE
State FL
ZIP 32086
Phone 904 797-2121
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2024
Certificate Expiration Date 1/27/2026
Facility Type Physician Office
Lab Director ALIYA M. YASIN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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