25D0966549 CLIA NUMBER - PEDIATRIC CARE CENTER LLC

Laboratory Demographics

  • CLIA Code: 25D0966549
  • Facility Name: PEDIATRIC CARE CENTER LLC
  • Facility Address: 4105 HOSPITAL RD STE 104
    PASCAGOULA, MS
    ZIP 39581
  • Facility Phone: 228 762-9595
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. YOLANDA A. GUTIERREZ
  • NPI Number: 1083719256
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 25D0966549
LAB Type Physician Office
Facility Name PEDIATRIC CARE CENTER LLC
Street 4105 HOSPITAL RD STE 104
City PASCAGOULA
State MS
ZIP 39581
Phone 228 762-9595
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2025
Certificate Expiration Date 10/19/2027
Facility Type Physician Office
Lab Director DR. YOLANDA A. GUTIERREZ

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