19D2294631 CLIA NUMBER - PEDIATRICS REIMAGINED LLC

Laboratory Demographics

  • CLIA Code: 19D2294631
  • Facility Name: PEDIATRICS REIMAGINED LLC
  • Facility Address: 1901 US HIGHWAY 190, SUITE 9
    MANDEVILLE, LA
    ZIP 70448
  • Facility Phone: 504 343-4714
  • Facility Type: Other - PED URGENT CARE
  • Facility Type: Waiver
  • Lab Director: TIFFANY R. SPICUZZA
  • NPI Number: 1356123350
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2294631
LAB Type Other - PED URGENT CARE
Facility Name PEDIATRICS REIMAGINED LLC
Street 1901 US HIGHWAY 190, SUITE 9
City MANDEVILLE
State LA
ZIP 70448
Phone 504 343-4714
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2023
Certificate Expiration Date 11/27/2025
Facility Type Other - PED URGENT CARE
Lab Director TIFFANY R. SPICUZZA

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