05D1102479 CLIA NUMBER - WELLSPACE HEALTH OAK PARK COMMUNITY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 05D1102479
  • Facility Name: WELLSPACE HEALTH OAK PARK COMMUNITY HEALTH CENTER
  • Facility Address: 3415 MARTIN LUTHER KING JR BLVD
    SACRAMENTO, CA
    ZIP 95817
  • Facility Phone: 916 737-5555
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. JANINE W. BERA
  • NPI Number: 1811262348
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1102479
LAB Type Federally Qualified Health Center
Facility Name WELLSPACE HEALTH OAK PARK COMMUNITY HEALTH CENTER
Street 3415 MARTIN LUTHER KING JR BLVD
City SACRAMENTO
State CA
ZIP 95817
Phone 916 737-5555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2024
Certificate Expiration Date 3/16/2026
Facility Type Federally Qualified Health Center
Lab Director DR. JANINE W. BERA

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