45D0944605 CLIA NUMBER - SOUTHEAST DERMATOLOGY, PA

Laboratory Demographics

  • CLIA Code: 45D0944605
  • Facility Name: SOUTHEAST DERMATOLOGY, PA
  • Facility Address: 4419 CRENSHAW ROAD
    PASADENA, TX
    ZIP 77504
  • Facility Phone: 281 481-0033
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MATTHEW S. PETITT
  • NPI Number: 1811932205
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 45D0944605
LAB Type Physician Office
Facility Name SOUTHEAST DERMATOLOGY, PA
Street 4419 CRENSHAW ROAD
City PASADENA
State TX
ZIP 77504
Phone 281 481-0033
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/15/2024
Certificate Expiration Date 4/14/2026
Facility Type Physician Office
Lab Director MATTHEW S. PETITT

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