45D2269631 CLIA NUMBER - BLUE SKY PEDIATRICS

Laboratory Demographics

  • CLIA Code: 45D2269631
  • Facility Name: BLUE SKY PEDIATRICS
  • Facility Address: 878 S. DENTON TAP RD SUITE 250
    COPPELL, TX
    ZIP 75019
  • Facility Phone: 972 636-4016
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SAYAKA IMAGAWA
  • NPI Number: 1891427613
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D2269631
LAB Type Physician Office
Facility Name BLUE SKY PEDIATRICS
Street 878 S. DENTON TAP RD SUITE 250
City COPPELL
State TX
ZIP 75019
Phone 972 636-4016
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/29/2024
Certificate Expiration Date 9/28/2026
Facility Type Physician Office
Lab Director SAYAKA IMAGAWA

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