05D2040420 CLIA NUMBER - SOUTH GATE COMMUNITY CLINIC

Laboratory Demographics

  • CLIA Code: 05D2040420
  • Facility Name: SOUTH GATE COMMUNITY CLINIC
  • Facility Address: 5720 IMPERIAL HWY STE N-O
    SOUTH GATE, CA
    ZIP 90280
  • Facility Phone: 323 776-1500
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: HENRY AWARIEFE
  • NPI Number: 1801138698
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2040420
LAB Type Community Clinic
Facility Name SOUTH GATE COMMUNITY CLINIC
Street 5720 IMPERIAL HWY STE N-O
City SOUTH GATE
State CA
ZIP 90280
Phone 323 776-1500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2024
Certificate Expiration Date 4/29/2026
Facility Type Community Clinic
Lab Director HENRY AWARIEFE

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