12D1073204 CLIA NUMBER - PACIFIC ENDOSCOPY CENTER LLC DBA PACIFIC ENDOSCOPY CENTER (PEC)

Laboratory Demographics

  • CLIA Code: 12D1073204
  • Facility Name: PACIFIC ENDOSCOPY CENTER LLC DBA PACIFIC ENDOSCOPY CENTER (PEC)
  • Facility Address: 1029 MAKOLU ST SUITE H
    PEARL CITY, HI
    ZIP 96782
  • Facility Phone: 808 456-6420
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DEMETRIO JR G. OBALDO
  • NPI Number: 1841316841
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 12D1073204
LAB Type Ambulatory Surgery Center
Facility Name PACIFIC ENDOSCOPY CENTER LLC DBA PACIFIC ENDOSCOPY CENTER (PEC)
Street 1029 MAKOLU ST SUITE H
City PEARL CITY
State HI
ZIP 96782
Phone 808 456-6420
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2024
Certificate Expiration Date 5/19/2026
Facility Type Ambulatory Surgery Center
Lab Director DEMETRIO JR G. OBALDO

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