Provider Demographics
NPI:1619586930
Name:ONESTOP MOBILE PHLEBOTOMY
Entity Type:Organization
Organization Name:ONESTOP MOBILE PHLEBOTOMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PHLEBOTOMY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:805-803-6595
Mailing Address - Street 1:4214 E LOS ANGELES AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3373
Mailing Address - Country:US
Mailing Address - Phone:805-803-6595
Mailing Address - Fax:
Practice Address - Street 1:4214 E LOS ANGELES AVE APT 2
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3373
Practice Address - Country:US
Practice Address - Phone:805-803-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACPT-01003405OtherCALIFORNIA DEPT OF PUBLIC HEALTH