05D2055670 CLIA NUMBER - WELLSPACE HEALTH ROSEVILLE COMMUNITY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 05D2055670
  • Facility Name: WELLSPACE HEALTH ROSEVILLE COMMUNITY HEALTH CENTER
  • Facility Address: 5 MEDICAL PLAZA DR, STE 170
    ROSEVILLE, CA
    ZIP 95661
  • Facility Phone: 916 978-1738
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: JANINE BERA MD
  • NPI Number: 1811262348
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2055670
LAB Type Federally Qualified Health Center
Facility Name WELLSPACE HEALTH ROSEVILLE COMMUNITY HEALTH CENTER
Street 5 MEDICAL PLAZA DR, STE 170
City ROSEVILLE
State CA
ZIP 95661
Phone 916 978-1738
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2023
Certificate Expiration Date 5/6/2025
Facility Type Federally Qualified Health Center
Lab Director JANINE BERA MD

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This page was last updated on: 3/20/2025