Healthcare Provider Details

I. General information

NPI: 1770211260
Provider Name (Legal Business Name): PHLEBO MOBILE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 HUTTON AVE
FARMINGTON NM
87402-7601
US

IV. Provider business mailing address

1305 HUTTON AVE
FARMINGTON NM
87402-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-330-6953
  • Fax: 505-258-4356
Mailing address:
  • Phone: 505-330-6953
  • Fax: 505-258-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MISS HEATHER ROSE CHARLIE
Title or Position: OWNER/ADMINISTRATOR/NCPT
Credential: NCPT
Phone: 505-330-6953