05D1014132 CLIA NUMBER - ST JOHN'S COMMUNITY HEALTH

Laboratory Demographics

  • CLIA Code: 05D1014132
  • Facility Name: ST JOHN'S COMMUNITY HEALTH
  • Facility Address: 1910 S MAGNOLIA AVE STE 101
    LOS ANGELES, CA
    ZIP 90007
  • Facility Phone: 323 541-1600
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. SUSHANT BANDARPALLE
  • NPI Number: 1003068206
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1014132
LAB Type Federally Qualified Health Center
Facility Name ST JOHN'S COMMUNITY HEALTH
Street 1910 S MAGNOLIA AVE STE 101
City LOS ANGELES
State CA
ZIP 90007
Phone 323 541-1600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2024
Certificate Expiration Date 3/11/2026
Facility Type Federally Qualified Health Center
Lab Director DR. SUSHANT BANDARPALLE

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