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General NPI Number Information
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NPI Number | 1518375948
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Entity Type | Organization
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Legal Business Name | COMPLETE BLOOD COLLECTION MOBILE PHLEBOTOMY
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 5306 HARRISON ST
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City | NORTH HIGHLANDS
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State | CA
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Zip | 95660-5414
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Country | US
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Telephone | 916-692-5644
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Fax | 916-900-4497
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Provider Business Mailing Address
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Address Line | 5306 HARRISON ST
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City | NORTH HIGHLANDS
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State | CA
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Zip | 95660-5414
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Country | US
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Telephone | 916-692-5644
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Fax | 916-900-4497
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Authorized Official
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Title or Position | OWNER/PHLEBOTOMIST
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Name | MR. ROBERT GLENN COOK
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Credential | CPT 1
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Telephone | 916-692-5644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 00026656
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 00024537
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License Number State | CA
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