05D0959382 CLIA NUMBER - JACQUELINE G AGCAOILI MD

Laboratory Demographics

  • CLIA Code: 05D0959382
  • Facility Name: JACQUELINE G AGCAOILI MD
  • Facility Address: 4440 BROCKTON AVE STE 320
    RIVERSIDE, CA
    ZIP 92501
  • Facility Phone: 951 369-6191
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACQUELINE G. AGCAOILI MD
  • NPI Number: 1124022108
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0959382
LAB Type Physician Office
Facility Name JACQUELINE G AGCAOILI MD
Street 4440 BROCKTON AVE STE 320
City RIVERSIDE
State CA
ZIP 92501
Phone 951 369-6191
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Physician Office
Lab Director JACQUELINE G. AGCAOILI MD

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