Healthcare Provider Details

I. General information

NPI: 1104708528
Provider Name (Legal Business Name): HEALTH CARE CONNECT MOBILE PHLEBOTOMY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AHTANUM RD
UNION GAP WA
98903-1538
US

IV. Provider business mailing address

6903 CHINOOK DR
YAKIMA WA
98908-1644
US

V. Phone/Fax

Practice location:
  • Phone: 509-907-8983
  • Fax:
Mailing address:
  • Phone: 509-907-8983
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA SALAZAR
Title or Position: OWNER/MANAGER
Credential:
Phone: 509-907-8973