45D2066233 CLIA NUMBER - PEDISTAT

Laboratory Demographics

  • CLIA Code: 45D2066233
  • Facility Name: PEDISTAT
  • Facility Address: 205 E MEDICAL CENTER BLVD
    WEBSTER, TX
    ZIP 77598
  • Facility Phone: 713 929-0040
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAGINI P. MIRYALA
  • NPI Number: 1487077525
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2066233
LAB Type Physician Office
Facility Name PEDISTAT
Street 205 E MEDICAL CENTER BLVD
City WEBSTER
State TX
ZIP 77598
Phone 713 929-0040
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/15/2025
Certificate Expiration Date 1/14/2027
Facility Type Physician Office
Lab Director RAGINI P. MIRYALA

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