05D2063286 CLIA NUMBER - WELLSPACE HEALTH MARTIN LUTHER KING JR VILLAGE

Laboratory Demographics

  • CLIA Code: 05D2063286
  • Facility Name: WELLSPACE HEALTH MARTIN LUTHER KING JR VILLAGE
  • Facility Address: 3900 47TH AVE.
    SACRAMENTO, CA
    ZIP 95824
  • Facility Phone: 916 550-5481
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: JANINE BERA MD
  • NPI Number: 1346765351
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2063286
LAB Type Federally Qualified Health Center
Facility Name WELLSPACE HEALTH MARTIN LUTHER KING JR VILLAGE
Street 3900 47TH AVE.
City SACRAMENTO
State CA
ZIP 95824
Phone 916 550-5481
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