19D2089699 CLIA NUMBER - EAST JEFFERSON FAMILY PRACTICE

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Laboratory Demographics

CLIA Number: 19D2089699

Facility Name: EAST JEFFERSON FAMILY PRACTICE

Facility Address:
2109 DAVIO DRIVE
METAIRIE, LA
ZIP 70003
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Facility Phone Number: 504 885-2505

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1225085525

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	19D2089699
LAB Type	Physician Office
Facility Name	EAST JEFFERSON FAMILY PRACTICE
Street	2109 DAVIO DRIVE
City	METAIRIE
State	LA
ZIP	70003
Phone	504 885-2505
CertificateType	4
CertificateEffectiveDate	1/7/2023
CertificateExpirationDate	1/6/2025
FacilityType	Waiver

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