38D2055904 CLIA NUMBER - PEDIATRIC TLC PC

Laboratory Demographics

  • CLIA Code: 38D2055904
  • Facility Name: PEDIATRIC TLC PC
  • Facility Address: 1819 NEBRASKA AVE
    GRANTS PASS, OR
    ZIP 97527
  • Facility Phone: 541 479-2411
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MARTENIA YVONNE
  • NPI Number: 1548930464
  • Taxonomy: 363LP0200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 38D2055904
LAB Type Practitioner Other
Facility Name PEDIATRIC TLC PC
Street 1819 NEBRASKA AVE
City GRANTS PASS
State OR
ZIP 97527
Phone 541 479-2411
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Practitioner Other
Lab Director MARTENIA YVONNE

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