Provider Demographics
NPI:1164657144
Name:ABQ MOBILE BLOOD SERVICE
Entity Type:Organization
Organization Name:ABQ MOBILE BLOOD SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCUDERO
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:505-974-9177
Mailing Address - Street 1:11101 FIESTA PARK NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5275
Mailing Address - Country:US
Mailing Address - Phone:505-974-9177
Mailing Address - Fax:505-508-2022
Practice Address - Street 1:11101 FIESTA PARK NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5275
Practice Address - Country:US
Practice Address - Phone:505-974-9177
Practice Address - Fax:505-508-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20-0034R06253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care