45D2063402 CLIA NUMBER - NORTHEAST CORNERSTONE PEDIATRICS PA

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Laboratory Demographics

CLIA Number: 45D2063402

Facility Name: NORTHEAST CORNERSTONE PEDIATRICS PA

Facility Address:
3660 JOE BATTLE BLVD SUITE 8
EL PASO, TX
ZIP 79938
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Facility Phone Number: 915 821-5900

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174670533

Taxonomy: 2080A0000X - Pediatrics
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

CLIA Record

Field Name	Field Value
CLIA Number	45D2063402
LAB Type	Physician Office
Facility Name	NORTHEAST CORNERSTONE PEDIATRICS PA
Street	3660 JOE BATTLE BLVD SUITE 8
City	EL PASO
State	TX
ZIP	79938
Phone	915 821-5900
CertificateType	4
CertificateEffectiveDate	8/1/2023
CertificateExpirationDate	7/31/2025
FacilityType	Waiver

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