10D2117192 CLIA NUMBER - COASTAL PEDIATRIC GROUP, LLC

Laboratory Demographics

  • CLIA Code: 10D2117192
  • Facility Name: COASTAL PEDIATRIC GROUP, LLC
  • Facility Address: 91 MACK BAYOU LOOP
    SANTA ROSA BEACH, FL
    ZIP 32459
  • Facility Phone: 850 659-6556
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUSANNA BUCHHOLZ
  • NPI Number: 1417304643
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D2117192
LAB Type Physician Office
Facility Name COASTAL PEDIATRIC GROUP, LLC
Street 91 MACK BAYOU LOOP
City SANTA ROSA BEACH
State FL
ZIP 32459
Phone 850 659-6556
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Physician Office
Lab Director SUSANNA BUCHHOLZ

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