03D2256919 CLIA NUMBER - AGAVE PHYSICIAN SERVICES LLC

Laboratory Demographics

  • CLIA Code: 03D2256919
  • Facility Name: AGAVE PHYSICIAN SERVICES LLC
  • Facility Address: 3240 E UNION HILLS DR STE 145B
    PHOENIX, AZ
    ZIP 85050
  • Facility Phone: 602 855-3500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GREG ALAESTANTE
  • NPI Number: 1053082263
  • Taxonomy: 207RH0002X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2256919
LAB Type Physician Office
Facility Name AGAVE PHYSICIAN SERVICES LLC
Street 3240 E UNION HILLS DR STE 145B
City PHOENIX
State AZ
ZIP 85050
Phone 602 855-3500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2024
Certificate Expiration Date 3/28/2026
Facility Type Physician Office
Lab Director GREG ALAESTANTE

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