Healthcare Provider Details

I. General information

NPI: 1306266747
Provider Name (Legal Business Name): GENTLE TOUCH MOBILE PHLEBOTOMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 KIRKLAND ST
DELTONA FL
32738-3121
US

IV. Provider business mailing address

2918 KIRKLAND ST
DELTONA FL
32738-3121
US

V. Phone/Fax

Practice location:
  • Phone: 386-334-0616
  • Fax:
Mailing address:
  • Phone:
  • 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: KELLI-ANN MEZA
Title or Position: PHLEBOTOMIST
Credential:
Phone: 386-334-0616