10D2103179 CLIA NUMBER - EAST LAKE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 10D2103179
  • Facility Name: EAST LAKE PEDIATRICS
  • Facility Address: 200 PINE AVE N SUITE A
    OLDSMAR, FL
    ZIP 34677
  • Facility Phone: 727 372-6760
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MICHAEL C. JORDAN
  • NPI Number: 1144343617
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D2103179
LAB Type Physician Office
Facility Name EAST LAKE PEDIATRICS
Street 200 PINE AVE N SUITE A
City OLDSMAR
State FL
ZIP 34677
Phone 727 372-6760
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type Physician Office
Lab Director MICHAEL C. JORDAN

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