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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

PRIME WELLNESS COMMUNITY HEALTH CENTER
NPI 1083251532
Clinic/Center - Federally Qualified Health Center (FQHC) in Los Angeles, CA

Active since December 03, 2019CLIA 05D2222510 · Waiver
8610 S SEPULVEDA BLVD STE 104, LOS ANGELES, CA 90045(310) 659-7867(310) 878-2118 Get Directions Write a Review

NPPES record last updated: July 9, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 9, 2026, Feb 5, 2025, Jun 9, 2021 and 3 more (6 updates tracked since 2019).

About Prime Wellness Community Health Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRIME WELLNESS COMMUNITY HEALTH CENTER (NPI 1083251532) is a healthcare organization registered as a federally qualified health center (fqhc) in Los Angeles, California and active in the NPI registry since December 2019. The organization holds a CLIA Waiver certificate valid through April 28, 2027, maintains a secondary practice location in Inglewood, and lists Denys Slesarenko, Ceo, as its authorized official.

NPPES Registry Identity

NPI1083251532
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NamePRIME WELLNESS COMMUNITY HEALTH CENTER
Location Address8610 S SEPULVEDA BLVD STE 104Los Angeles, CA 90045-4009
Mailing Address8610 S Sepulveda Blvd Ste 104Los Angeles, CA 90045-4009 · (310) 659-7867 · Fax (310) 878-2118
Phone(310) 659-7867
Fax(310) 878-2118
Organization SubpartNo
Authorized OfficialDenys SlesarenkoCeo · (310) 659-7867
Enumeration DateDecember 3, 2019
Last NPPES UpdateJuly 9, 20266 updates tracked since enumeration
NPPES CertifiedJuly 9, 2026
✔ NPI 1083251532 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
8610 S SEPULVEDA BLVD STE 104, Los Angeles, CA 90045
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Secondary Practice Location 1

Location 1133 N Prairie Ave Ste BInglewood, CA 90301-4879 · Phone (310) 419-2223 · Fax (310) 419-2226

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2222510

Prime Wellness Community Health Center · Los Angeles, CA
Active · expires Apr 28, 2027
CLIA Number05D2222510
Laboratory TypeCommunity Clinic
Certificate Effective DateApril 29, 2025
Certificate Expiration DateApril 28, 2027
Laboratory DirectorNicolette Balloou
Laboratory Phone(310) 659-7867
Laboratory LocationPrime Wellness Community Health Center8610 S Sepulveda Blvd Ste 104, Los Angeles, CA 90045
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Prime Wellness Community Health Center's NPI number?

The NPI number for Prime Wellness Community Health Center is 1083251532. It was assigned to this organization in the NPPES registry on December 3, 2019.

Where is Prime Wellness Community Health Center located?

Prime Wellness Community Health Center is located at 8610 S Sepulveda Blvd Ste 104, Los Angeles, CA 90045. The listed phone number is (310) 659-7867.

What is Prime Wellness Community Health Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Prime Wellness Community Health Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2222510) is associated with this NPI, valid through April 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Prime Wellness Community Health Center was last updated on July 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 46 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.