05D2283992 CLIA NUMBER - ALTAMED PACE- WALNUT PARK

Laboratory Demographics

CLIA Code: 05D2283992
Facility Name: ALTAMED PACE- WALNUT PARK
Facility Address: 7716 ALAMEDA STREET
HUNTINGTON PARK, CA
ZIP 90255
Facility Phone: 323 765-6166
Facility Type: Federally Qualified Health Center
Facility Type: Waiver
Lab Director: ISSAM KHAFAJA
NPI Number: 1942431374
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	05D2283992
LAB Type	Federally Qualified Health Center
Facility Name	ALTAMED PACE- WALNUT PARK
Street	7716 ALAMEDA STREET
City	HUNTINGTON PARK
State	CA
ZIP	90255
Phone	323 765-6166
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	ISSAM KHAFAJA

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