05D2294378 CLIA NUMBER - AGILE OCCUPATIONAL MEDICINE, PC

Laboratory Demographics

  • CLIA Code: 05D2294378
  • Facility Name: AGILE OCCUPATIONAL MEDICINE, PC
  • Facility Address: 1180 BRAODWAY STREET
    KING CITY, CA
    ZIP 93930
  • Facility Phone: 760 828-5681
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MINH NGUYEN
  • NPI Number: 1740970979
  • Taxonomy: 261QX0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2294378
LAB Type Physician Office
Facility Name AGILE OCCUPATIONAL MEDICINE, PC
Street 1180 BRAODWAY STREET
City KING CITY
State CA
ZIP 93930
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