Healthcare Provider Details

I. General information

NPI: 1710896279
Provider Name (Legal Business Name): CRYSTAL CLEAR MOBILE PHLEBOTOMY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NORTH CONGRESS AVE BUILDING H #310
WEST PALM BEACH FL
33401
US

IV. Provider business mailing address

1691 FORUM PL STE B
WEST PALM BEACH FL
33401-2336
US

V. Phone/Fax

Practice location:
  • Phone: 561-727-6118
  • Fax:
Mailing address:
  • Phone: 561-727-6118
  • 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: MS. CRYSTAL UPSHAW
Title or Position: OWNER
Credential: RPT
Phone: 561-727-6118