Provider Demographics
NPI:1518375948
Name:COMPLETE BLOOD COLLECTION MOBILE PHLEBOTOMY
Entity type:Organization
Organization Name:COMPLETE BLOOD COLLECTION MOBILE PHLEBOTOMY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHLEBOTOMIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:CPT 1
Authorized Official - Phone:916-692-5644
Mailing Address - Street 1:5306 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5414
Mailing Address - Country:US
Mailing Address - Phone:916-692-5644
Mailing Address - Fax:916-900-4497
Practice Address - Street 1:5306 HARRISON ST
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5414
Practice Address - Country:US
Practice Address - Phone:916-692-5644
Practice Address - Fax:916-900-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00026656291U00000X
CA00024537291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory