05D2004070 CLIA NUMBER - JWCH MEDICAL CLINIC AT CHARLES COBB HOTEL

Laboratory Demographics

  • CLIA Code: 05D2004070
  • Facility Name: JWCH MEDICAL CLINIC AT CHARLES COBB HOTEL
  • Facility Address: 521 S SAN PEDRO ST
    LOS ANGELES, CA
    ZIP 90013
  • Facility Phone: 323 201-4516
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: PAUL GREGERSON
  • NPI Number: 1528515152
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2004070
LAB Type Federally Qualified Health Center
Facility Name JWCH MEDICAL CLINIC AT CHARLES COBB HOTEL
Street 521 S SAN PEDRO ST
City LOS ANGELES
State CA
ZIP 90013
Phone 323 201-4516
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/24/2024
Certificate Expiration Date 2/23/2026
Facility Type Federally Qualified Health Center
Lab Director PAUL GREGERSON

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