Healthcare Provider Details

I. General information

NPI: 1457179335
Provider Name (Legal Business Name): DLG MOBILE LAB SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6064 CAUSEWAY BLVD
TAMPA FL
33619-6206
US

IV. Provider business mailing address

6064 CAUSEWAY BLVD
TAMPA FL
33619-6206
US

V. Phone/Fax

Practice location:
  • Phone: 813-812-9868
  • Fax: 813-999-1046
Mailing address:
  • Phone: 813-812-9868
  • Fax: 813-999-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMPARO RODRIGUEZ NIEVES
Title or Position: OWNER
Credential: PHLEBOTOMY
Phone: 813-812-9868