12D2165270 CLIA NUMBER - PANIOLO PEDIATRIC AND FAMILY MEDICINE, INC

Laboratory Demographics

CLIA Number: 12D2165270

Facility Name: PANIOLO PEDIATRIC AND FAMILY MEDICINE, INC

Facility Address:
64-1032 MAMALAHOA HWY, SUITE 201
KAMUELA, HI
ZIP 96743
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Facility Phone Number: 808 885-1878

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790162980

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	12D2165270
LAB Type	Physician Office
Facility Name	PANIOLO PEDIATRIC AND FAMILY MEDICINE, INC
Street	64-1032 MAMALAHOA HWY, SUITE 201
City	KAMUELA
State	HI
ZIP	96743
Phone	808 885-1878
CertificateType	4
CertificateEffectiveDate	4/23/2023
CertificateExpirationDate	4/22/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024