45D0956840 CLIA NUMBER - CHILDRENS CLINIC DIMMIT AND ZAVALA PA,THE

Laboratory Demographics

CLIA Number: 45D0956840

Facility Name: CHILDRENS CLINIC DIMMIT AND ZAVALA PA,THE

Facility Address:
403 S 7TH STREET
CARRIZO SPRINGS, TX
ZIP 78834
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Facility Phone Number: 830 876-9870

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1972664613

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D0956840
LAB Type	Physician Office
Facility Name	CHILDRENS CLINIC DIMMIT AND ZAVALA PA,THE
Street	403 S 7TH STREET
City	CARRIZO SPRINGS
State	TX
ZIP	78834
Phone	830 876-9870
CertificateType	4
CertificateEffectiveDate	3/28/2024
CertificateExpirationDate	3/27/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024