=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871480152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOJICA PHLEBOTOMY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2025
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 807 ESPANOLA WAY
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32901-4103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-550-2401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 807 ESPANOLA WAY
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32901-4103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-550-2401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHLEBOTOMIST
-----------------------------------------------------
Name | LYDIA SOPHIA MOJICA
-----------------------------------------------------
Credential | CPT
-----------------------------------------------------
Telephone | 321-550-2401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------