05D2058801 CLIA NUMBER - WELLSPACE HEALTH RANCHO CORDOVA COMMUNITY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 05D2058801
  • Facility Name: WELLSPACE HEALTH RANCHO CORDOVA COMMUNITY HEALTH CENTER
  • Facility Address: 10423 OLD PLACERVILLE RD STE A
    SACRAMENTO, CA
    ZIP 95827
  • Facility Phone: 916 679-3925
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. JANINE W. BERA
  • NPI Number: 1437404654
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2058801
LAB Type Federally Qualified Health Center
Facility Name WELLSPACE HEALTH RANCHO CORDOVA COMMUNITY HEALTH CENTER
Street 10423 OLD PLACERVILLE RD STE A
City SACRAMENTO
State CA
ZIP 95827
Phone 916 679-3925
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2024
Certificate Expiration Date 1/7/2026
Facility Type Federally Qualified Health Center
Lab Director DR. JANINE W. BERA

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