45D2116334 CLIA NUMBER - KINGS MEDICINE

Laboratory Demographics

  • CLIA Code: 45D2116334
  • Facility Name: KINGS MEDICINE
  • Facility Address: 1342 W GOODWIN
    PLEASANTON, TX
    ZIP 78064
  • Facility Phone: 830 569-0051
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DIKI REYES
  • NPI Number: 1144631466
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2116334
LAB Type Practitioner Other
Facility Name KINGS MEDICINE
Street 1342 W GOODWIN
City PLEASANTON
State TX
ZIP 78064
Phone 830 569-0051
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/25/2024
Certificate Expiration Date 7/24/2026
Facility Type Practitioner Other
Lab Director DIKI REYES

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