45D2266183 CLIA NUMBER - MAGNOLIA DERMATOLOGY OF FRISCO, PLLC

Laboratory Demographics

  • CLIA Code: 45D2266183
  • Facility Name: MAGNOLIA DERMATOLOGY OF FRISCO, PLLC
  • Facility Address: 13192 DALLAS PKWY SUITE 620
    FRISCO, TX
    ZIP 75034
  • Facility Phone: 214 914-3322
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CARLA A. GUSTOVICH
  • NPI Number: 1215581780
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D2266183
LAB Type Physician Office
Facility Name MAGNOLIA DERMATOLOGY OF FRISCO, PLLC
Street 13192 DALLAS PKWY SUITE 620
City FRISCO
State TX
ZIP 75034
Phone 214 914-3322
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/8/2024
Certificate Expiration Date 8/7/2026
Facility Type Physician Office
Lab Director CARLA A. GUSTOVICH

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