10D2081770 CLIA NUMBER - BLOSSOM PEDIATRIC CARE

Laboratory Demographics

  • CLIA Code: 10D2081770
  • Facility Name: BLOSSOM PEDIATRIC CARE
  • Facility Address: 507 E DR MARTIN LUTHER KING JR STE 112
    TAMPA, FL
    ZIP 33603
  • Facility Phone: 813 229-6139
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DURGA P. CHINTAKAYALA
  • NPI Number: 1629208509
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2081770
LAB Type Physician Office
Facility Name BLOSSOM PEDIATRIC CARE
Street 507 E DR MARTIN LUTHER KING JR STE 112
City TAMPA
State FL
ZIP 33603
Phone 813 229-6139
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2024
Certificate Expiration Date 7/29/2026
Facility Type Physician Office
Lab Director DURGA P. CHINTAKAYALA

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