Provider Demographics
NPI:1376114546
Name:IMPERIAL VALLEY MOBILE PHLEBOTOMY
Entity Type:Organization
Organization Name:IMPERIAL VALLEY MOBILE PHLEBOTOMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CPT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIC
Authorized Official - Middle Name:BURGUNDI
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:442-340-4706
Mailing Address - Street 1:1621 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9664
Mailing Address - Country:US
Mailing Address - Phone:442-340-4706
Mailing Address - Fax:
Practice Address - Street 1:1621 VIRGINIA LN
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9664
Practice Address - Country:US
Practice Address - Phone:442-340-4706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty