=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851187835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEEDLES ON WHEELS MOBILE PHLEBOTOMY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2025
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7869 VENTURA CANYON AVE UNIT 202
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-6361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-731-1009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7869 VENTURA CANYON AVE UNIT 202
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-6361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-731-1009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/OWNER
-----------------------------------------------------
Name | DOMINGO H TIAMZON JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-731-1009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------