38D0624959 CLIA NUMBER - WESTSIDE PEDIATRIC CLINIC, PC

Laboratory Demographics

  • CLIA Code: 38D0624959
  • Facility Name: WESTSIDE PEDIATRIC CLINIC, PC
  • Facility Address: 9555 SW BARNES RD #270
    PORTLAND, OR
    ZIP 97225
  • Facility Phone: (503) 297-1025
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FAYE JOHNSON
  • NPI Number: 1093929226
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 38D0624959
LAB Type Physician Office
Facility Name WESTSIDE PEDIATRIC CLINIC, PC
Street 9555 SW BARNES RD #270
City PORTLAND
State OR
ZIP 97225
Phone 5032971025
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Physician Office
Lab Director FAYE JOHNSON

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This page was last updated on: 5/18/2026