05D2301992 CLIA NUMBER - BLACK WELLNESS & PROSPERITY CENTER

Laboratory Demographics

  • CLIA Code: 05D2301992
  • Facility Name: BLACK WELLNESS & PROSPERITY CENTER
  • Facility Address: 2201 CALAVERAS STREET
    FRESNO, CA
    ZIP 93721
  • Facility Phone: 559 790-1905
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: SERGIO D. ILIC,
  • NPI Number: 1619591179
  • Taxonomy: 374J00000X - Doula

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CLIA Record

Field Name Field Value
CLIA Number 05D2301992
LAB Type Community Clinic
Facility Name BLACK WELLNESS & PROSPERITY CENTER
Street 2201 CALAVERAS STREET
City FRESNO
State CA
ZIP 93721
Phone 559 790-1905
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2024
Certificate Expiration Date 4/2/2026
Facility Type Community Clinic
Lab Director SERGIO D. ILIC,

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