Healthcare Provider Details

I. General information

NPI: 1538670591
Provider Name (Legal Business Name): VALDEZ MOBILE PHLEBOTOMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41385 FISH HATCHERY DR
SCIO OR
97374-9745
US

IV. Provider business mailing address

41385 FISH HATCHERY DR
SCIO OR
97374-9745
US

V. Phone/Fax

Practice location:
  • Phone: 971-240-0995
  • Fax: 503-296-2629
Mailing address:
  • Phone: 971-240-0995
  • Fax: 503-296-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHRISTIAN WILLIAM VALDEZ II
Title or Position: OWNER
Credential:
Phone: 971-240-0995