Provider Demographics
NPI:1851541122
Name:INDEPENDENT PHLEBOTOMY SERVICES
Entity Type:Organization
Organization Name:INDEPENDENT PHLEBOTOMY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ CPT-1
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PEREZ
Authorized Official - Last Name:ARGUIJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-409-1189
Mailing Address - Street 1:535 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:535 W 4TH ST
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-3413
Practice Address - Country:US
Practice Address - Phone:626-409-1198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT25067302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization