Healthcare Provider Details

I. General information

NPI: 1609012079
Provider Name (Legal Business Name): COMPLETE PHLEBOTOMY TRAINING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44937 CLARO RD
HEMET CA
92544-6744
US

IV. Provider business mailing address

44937 CLARO RD
HEMET CA
92544-6744
US

V. Phone/Fax

Practice location:
  • Phone: 909-214-5909
  • Fax:
Mailing address:
  • Phone: 909-214-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN467742
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN467742
License Number StateCA

VIII. Authorized Official

Name: MS. WANDA KIM TARDY
Title or Position: DIRECTOR
Credential: RN
Phone: 909-214-5909