Healthcare Provider Details

I. General information

NPI: 1033735535
Provider Name (Legal Business Name): GENTLE BUTTERFLY PHLEBOTOMY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W CIVIC CENTER DR STE 200
SANTA ANA CA
92703-2383
US

IV. Provider business mailing address

901 W CIVIC CENTER DR
SANTA ANA CA
92703-2352
US

V. Phone/Fax

Practice location:
  • Phone: 951-407-5996
  • Fax:
Mailing address:
  • Phone: 951-407-5996
  • 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: EVANGELA AUGUST
Title or Position: OWNER
Credential:
Phone: 951-407-5996