Healthcare Provider Details

I. General information

NPI: 1104627314
Provider Name (Legal Business Name): LATRESCIA REEVES PHLEBOTOMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PURPLE HEART MOBILE PHLEBOTOMY & LA PURPLE HEART MOBILE PHLEBOTOMY & LA

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 TUCKER LN APT B1
BALTIMORE MD
21207-7839
US

IV. Provider business mailing address

2204 TUCKER LN APT B1
BALTIMORE MD
21207-7839
US

V. Phone/Fax

Practice location:
  • Phone: 443-717-7158
  • Fax:
Mailing address:
  • Phone: 804-940-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberA00215910
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: