Healthcare Provider Details

I. General information

NPI: 1508735952
Provider Name (Legal Business Name): MSD MOBILE BLOOD DRAW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LOMOND DR
PACIFICA CA
94044-2041
US

IV. Provider business mailing address

420 LOMOND DR
PACIFICA CA
94044-2041
US

V. Phone/Fax

Practice location:
  • Phone: 415-806-2772
  • Fax:
Mailing address:
  • Phone: 415-806-2772
  • 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: MIRIAM S DESIDERIO
Title or Position: CERTIFIED PHLEBOTOMIST TECHNICIAN
Credential: CPT
Phone: 415-806-2772