05D1046265 CLIA NUMBER - KATELLA WELLNESS CENTER

Laboratory Demographics

  • CLIA Code: 05D1046265
  • Facility Name: KATELLA WELLNESS CENTER
  • Facility Address: 4152 KATELLA AVE SUITE 201
    LOS ALAMITOS, CA
    ZIP 90720
  • Facility Phone: 562 598-0600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ETSEGENET T. AYELE
  • NPI Number: 1518944032
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1046265
LAB Type Physician Office
Facility Name KATELLA WELLNESS CENTER
Street 4152 KATELLA AVE SUITE 201
City LOS ALAMITOS
State CA
ZIP 90720
Phone 562 598-0600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Physician Office
Lab Director ETSEGENET T. AYELE

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