Healthcare Provider Details

I. General information

NPI: 1043048523
Provider Name (Legal Business Name): MOBILE PHLEBOTOMIST SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 OVERTON DR
SAN JACINTO CA
92582-4250
US

IV. Provider business mailing address

962 OVERTON DR
SAN JACINTO CA
92582-4250
US

V. Phone/Fax

Practice location:
  • Phone: 951-973-6030
  • Fax: 951-654-8600
Mailing address:
  • Phone: 951-973-6030
  • Fax: 951-654-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DIANA NEVAREZ
Title or Position: CEO
Credential: PHLEBOTOMIST
Phone: 951-973-6030