05D2170309 CLIA NUMBER - WESLEY HEALTH CENTERS MLK RECUPERATIVE CARE CENTER

Laboratory Demographics

  • CLIA Code: 05D2170309
  • Facility Name: WESLEY HEALTH CENTERS MLK RECUPERATIVE CARE CENTER
  • Facility Address: 1670 EAST 120THS STREET BUILDING 14
    LOS ANGELES, CA
    ZIP 90059
  • Facility Phone: 323 201-4516
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: PAUL GREGERSON
  • NPI Number: 1770988370
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2170309
LAB Type Federally Qualified Health Center
Facility Name WESLEY HEALTH CENTERS MLK RECUPERATIVE CARE CENTER
Street 1670 EAST 120THS STREET BUILDING 14
City LOS ANGELES
State CA
ZIP 90059
Phone 323 201-4516
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/7/2025
Certificate Expiration Date 8/6/2027
Facility Type Federally Qualified Health Center
Lab Director PAUL GREGERSON

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