19D2061589 CLIA NUMBER - CHILDREN'S INTERNATIONAL MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 19D2061589
  • Facility Name: CHILDREN'S INTERNATIONAL MEDICAL GROUP
  • Facility Address: 626 SUPERIOR AVENUE
    BOGALUSA, LA
    ZIP 70427
  • Facility Phone: 985 730-6670
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDUARDO J. HERNANDEZ
  • NPI Number: 1932630118
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2061589
LAB Type Physician Office
Facility Name CHILDREN'S INTERNATIONAL MEDICAL GROUP
Street 626 SUPERIOR AVENUE
City BOGALUSA
State LA
ZIP 70427
Phone 985 730-6670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/1/2025
Certificate Expiration Date 6/30/2027
Facility Type Physician Office
Lab Director EDUARDO J. HERNANDEZ

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