05D2299090 CLIA NUMBER - AGILE OCCUPATIONAL MEDICINE, PC

Laboratory Demographics

CLIA Number: 05D2299090

Facility Name: AGILE OCCUPATIONAL MEDICINE, PC

Facility Address:
285 N MERCY SPRINGS ROAD SUITE A
LOS BANOS, CA
ZIP 93635
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Facility Phone Number: 760 828-5681

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558051995

Taxonomy: 261QX0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2299090
LAB Type	Physician Office
Facility Name	AGILE OCCUPATIONAL MEDICINE, PC
Street	285 N MERCY SPRINGS ROAD SUITE A
City	LOS BANOS
State	CA
ZIP	93635
Phone	760 828-5681
CertificateType	4
CertificateEffectiveDate	2/13/2024
CertificateExpirationDate	2/12/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024