45D2132490 CLIA NUMBER - SPACE CENTER PRIMARY CARE PLLC

Laboratory Demographics

  • CLIA Code: 45D2132490
  • Facility Name: SPACE CENTER PRIMARY CARE PLLC
  • Facility Address: 907 BAY AREA BLVD STE B
    HOUSTON, TX
    ZIP 77058
  • Facility Phone: 281 286-6000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DERAN Y. WONG
  • NPI Number: 1033661715
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2132490
LAB Type Physician Office
Facility Name SPACE CENTER PRIMARY CARE PLLC
Street 907 BAY AREA BLVD STE B
City HOUSTON
State TX
ZIP 77058
Phone 281 286-6000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2025
Certificate Expiration Date 6/19/2027
Facility Type Physician Office
Lab Director DERAN Y. WONG

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