03D2162908 CLIA NUMBER - AGAPE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 03D2162908
  • Facility Name: AGAPE PRIMARY CARE
  • Facility Address: 14074 N 90TH DRIVE
    PEORIA, AZ
    ZIP 85381
  • Facility Phone: 623 219-7768
  • Facility Type: Other - HOUSE CALLS PRACTICE
  • Facility Type: Waiver
  • Lab Director: PAULINA SIMON
  • NPI Number: 1992236848
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2162908
LAB Type Other - HOUSE CALLS PRACTICE
Facility Name AGAPE PRIMARY CARE
Street 14074 N 90TH DRIVE
City PEORIA
State AZ
ZIP 85381
Phone 623 219-7768
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2025
Certificate Expiration Date 3/4/2027
Facility Type Other - HOUSE CALLS PRACTICE
Lab Director PAULINA SIMON

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