45D0686649 CLIA NUMBER - SOUTHEAST DERMATOLOGY, PA

Laboratory Demographics

  • CLIA Code: 45D0686649
  • Facility Name: SOUTHEAST DERMATOLOGY, PA
  • Facility Address: 11914 ASTORIA BLVD SUITE 570
    HOUSTON, TX
    ZIP 77089
  • Facility Phone: 281 481-0033
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MATTHEW S. PETITT
  • NPI Number: 1427395599
  • Taxonomy: 207RI0200X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0686649
LAB Type Physician Office
Facility Name SOUTHEAST DERMATOLOGY, PA
Street 11914 ASTORIA BLVD SUITE 570
City HOUSTON
State TX
ZIP 77089
Phone 281 481-0033
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 1/13/2024
Certificate Expiration Date 1/12/2026
Facility Type Physician Office
Lab Director MATTHEW S. PETITT

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