10D2116894 CLIA NUMBER - PEDIATRIC PHYSICIAN SERVICES INC

Laboratory Demographics

  • CLIA Code: 10D2116894
  • Facility Name: PEDIATRIC PHYSICIAN SERVICES INC
  • Facility Address: 5650 BOLLETTIERI BLVD
    BRADENTON, FL
    ZIP 34210
  • Facility Phone: 727 767-8596
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PHILIP MULARONI
  • NPI Number: 1679061295
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 10D2116894
LAB Type Physician Office
Facility Name PEDIATRIC PHYSICIAN SERVICES INC
Street 5650 BOLLETTIERI BLVD
City BRADENTON
State FL
ZIP 34210
Phone 727 767-8596
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2024
Certificate Expiration Date 8/2/2026
Facility Type Physician Office
Lab Director PHILIP MULARONI

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