05D2063284 CLIA NUMBER - WELLSPACE HEALTH BOULEVARD COURT

Laboratory Demographics

  • CLIA Code: 05D2063284
  • Facility Name: WELLSPACE HEALTH BOULEVARD COURT
  • Facility Address: 5321 STOCKTON BLVD
    SACRAMENTO, CA
    ZIP 95820
  • Facility Phone: 916 704-3573
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: JANINE BERA MD
  • NPI Number: 1104210608
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2063284
LAB Type Federally Qualified Health Center
Facility Name WELLSPACE HEALTH BOULEVARD COURT
Street 5321 STOCKTON BLVD
City SACRAMENTO
State CA
ZIP 95820
Phone 916 704-3573
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/31/2025
Certificate Expiration Date 7/30/2027
Facility Type Federally Qualified Health Center
Lab Director JANINE BERA MD

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