21D2204834 CLIA NUMBER - HISPANIC AMERICAN PEDIATRICS & FAMILY CARE LLC

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Laboratory Demographics

CLIA Number: 21D2204834

Facility Name: HISPANIC AMERICAN PEDIATRICS & FAMILY CARE LLC

Facility Address:
2255 CRAIN HWY UNIT 107
WALDORF, MD
ZIP 20601
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Facility Phone Number: 301 818-7272

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1093313652

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2204834
LAB Type	Physician Office
Facility Name	HISPANIC AMERICAN PEDIATRICS & FAMILY CARE LLC
Street	2255 CRAIN HWY UNIT 107
City	WALDORF
State	MD
ZIP	20601
Phone	301 818-7272
CertificateType	4
CertificateEffectiveDate	12/10/2022
CertificateExpirationDate	12/9/2024
FacilityType	Waiver

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