05D2295151 CLIA NUMBER - AGILE OCCUPATIONAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 05D2295151
  • Facility Name: AGILE OCCUPATIONAL MEDICINE PC
  • Facility Address: 420 ACACIA STREET SUITE 2
    STOCKTON, CA
    ZIP 95203
  • Facility Phone: 760 828-5681
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MINH NGUYEN
  • NPI Number: 1518657956
  • Taxonomy: 261QX0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2295151
LAB Type Physician Office
Facility Name AGILE OCCUPATIONAL MEDICINE PC
Street 420 ACACIA STREET SUITE 2
City STOCKTON
State CA
ZIP 95203
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 12/6/2023
Certificate Expiration Date 12/5/2025
Facility Type Physician Office
Lab Director MINH NGUYEN

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