Healthcare Provider Details

I. General information

NPI: 1508109216
Provider Name (Legal Business Name): AZ HOME PHLEBOTOMY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7312 N 70TH DR
GLENDALE AZ
85303-2109
US

IV. Provider business mailing address

7312 N 70TH DR
GLENDALE AZ
85303-2109
US

V. Phone/Fax

Practice location:
  • Phone: 602-672-6479
  • Fax:
Mailing address:
  • Phone: 602-672-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: ELENA DE'ON MCMULLEN
Title or Position: OWNER
Credential:
Phone: 602-672-6479