05D2283978 CLIA NUMBER - ALTAMED PACE - COMPTON

Laboratory Demographics

CLIA Code: 05D2283978
Facility Name: ALTAMED PACE - COMPTON
Facility Address: 2616 E ALONDRA BLVD
COMPTON, CA
ZIP 90220
Facility Phone: 310 632-0415
Facility Type: Federally Qualified Health Center
Facility Type: Waiver
Lab Director: ESIQUIO CASILLAS
NPI Number: 1982990859
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	05D2283978
LAB Type	Federally Qualified Health Center
Facility Name	ALTAMED PACE - COMPTON
Street	2616 E ALONDRA BLVD
City	COMPTON
State	CA
ZIP	90220
Phone	310 632-0415
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/15/2025
Certificate Expiration Date	6/14/2027
Facility Type	Federally Qualified Health Center
Lab Director	ESIQUIO CASILLAS

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