05D2019226 CLIA NUMBER - JWCH MEDICAL CLINIC (DWC)

Laboratory Demographics

  • CLIA Code: 05D2019226
  • Facility Name: JWCH MEDICAL CLINIC (DWC)
  • Facility Address: 442 S SAN PEDRO ST
    LOS ANGELES, CA
    ZIP 90013
  • Facility Phone: 213 484-1186
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: PAUL GREGERSON
  • NPI Number: 1831560028
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2019226
LAB Type Community Clinic
Facility Name JWCH MEDICAL CLINIC (DWC)
Street 442 S SAN PEDRO ST
City LOS ANGELES
State CA
ZIP 90013
Phone 213 484-1186
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Community Clinic
Lab Director PAUL GREGERSON

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