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General NPI Number Information
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NPI Number | 1235780503
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Entity Type | Organization
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Legal Business Name | VICTOR MOBILE PHLEBOTOMY SERVICES LLC
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 221 SW CHAPMAN AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-4328
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Country | US
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Telephone | 772-475-2033
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Fax | 772-207-5467
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Provider Business Mailing Address
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Address Line | 221 SW CHAPMAN AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-4328
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Country | US
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Telephone |
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Fax | 772-207-5467
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Authorized Official
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Title or Position | MOBILE PHLEBOTOMY SERVICES
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Name | CALVERT VICTOR
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Credential | MEDICAL ASSISTANCE
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Telephone | 772-475-2033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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