45D1063801 CLIA NUMBER - DICKERSON PEDIATRICS, PA

Laboratory Demographics

  • CLIA Code: 45D1063801
  • Facility Name: DICKERSON PEDIATRICS, PA
  • Facility Address: 4760 SWEETWATER BLVD, SUITE 102
    SUGAR LAND, TX
    ZIP 77479
  • Facility Phone: 281 491-5439
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CASSANDRA N. DICKERSON
  • NPI Number: 1467505404
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D1063801
LAB Type Physician Office
Facility Name DICKERSON PEDIATRICS, PA
Street 4760 SWEETWATER BLVD, SUITE 102
City SUGAR LAND
State TX
ZIP 77479
Phone 281 491-5439
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2025
Certificate Expiration Date 1/22/2027
Facility Type Physician Office
Lab Director CASSANDRA N. DICKERSON

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