Healthcare Provider Details

I. General information

NPI: 1750104311
Provider Name (Legal Business Name): ROSIA B. MOBILE PHLEBOTOMY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GARDENVILLE PKWY STE 114
WEST SENECA NY
14224-1387
US

IV. Provider business mailing address

40 GARDENVILLE PKWY STE 114
WEST SENECA NY
14224-1387
US

V. Phone/Fax

Practice location:
  • Phone: 716-939-1776
  • Fax:
Mailing address:
  • Phone: 716-939-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CANDACE LATTIMORE
Title or Position: OWNER
Credential:
Phone: 716-939-1776