05D2076655 CLIA NUMBER - AGOURA NEUROFEEDBACK INC

Laboratory Demographics

  • CLIA Code: 05D2076655
  • Facility Name: AGOURA NEUROFEEDBACK INC
  • Facility Address: 28720 ROADSIDE DR STE 200
    AGOURA HILLS, CA
    ZIP 91301
  • Facility Phone: 855 717-3268
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: MARK JAFFE, MD
  • NPI Number: 1457694747
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2076655
LAB Type Comp. Outpatient Rehab Facility
Facility Name AGOURA NEUROFEEDBACK INC
Street 28720 ROADSIDE DR STE 200
City AGOURA HILLS
State CA
ZIP 91301
Phone 855 717-3268
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2024
Certificate Expiration Date 4/22/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director MARK JAFFE, MD

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