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General NPI Number Information
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NPI Number | 1538686860
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Entity Type | Organization
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Legal Business Name | AZ MOBILE PHLEBOTOMY LLC
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14461 N FOUNTAIN HILLS BLVD
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-2855
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Country | US
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Telephone | 480-353-8344
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Fax |
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Provider Business Mailing Address
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Address Line | 14461 N FOUNTAIN HILLS BLVD
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-2855
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Country | US
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Telephone | 480-426-2629
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Fax | 480-427-3349
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Authorized Official
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Title or Position | OWNER/PHLEBOTOMIST
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Name | MRS. CRYSTAL LYNN PELLEGRINO
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Credential |
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Telephone | 480-426-2629
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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 | 7106
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License Number State | AZ
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