05D1097714 CLIA NUMBER - GRACELIGHT COMMUNITY HEALTH

Laboratory Demographics

  • CLIA Code: 05D1097714
  • Facility Name: GRACELIGHT COMMUNITY HEALTH
  • Facility Address: 4816 EAST 3RD ST
    LOS ANGELES, CA
    ZIP 90022
  • Facility Phone: 323 780-4510
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DEANAH A. JIBRIL
  • NPI Number: 1104075282
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1097714
LAB Type Federally Qualified Health Center
Facility Name GRACELIGHT COMMUNITY HEALTH
Street 4816 EAST 3RD ST
City LOS ANGELES
State CA
ZIP 90022
Phone 323 780-4510
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Federally Qualified Health Center
Lab Director DEANAH A. JIBRIL

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