05D2294375 CLIA NUMBER - AGILE OCCUPATIONAL MEDICINE, PC

Laboratory Demographics

  • CLIA Code: 05D2294375
  • Facility Name: AGILE OCCUPATIONAL MEDICINE, PC
  • Facility Address: 13847 E 14TH STREET SUITE 107
    SAN LEANDRO, CA
    ZIP 94578
  • Facility Phone: 760 828-5681
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MINH NGUYEN
  • NPI Number: 1144910589
  • Taxonomy: 261QX0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2294375
LAB Type Physician Office
Facility Name AGILE OCCUPATIONAL MEDICINE, PC
Street 13847 E 14TH STREET SUITE 107
City SAN LEANDRO
State CA
ZIP 94578
Phone 760 828-5681
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/22/2023
Certificate Expiration Date 11/21/2025
Facility Type Physician Office
Lab Director MINH NGUYEN

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