Provider Demographics
NPI:1205526993
Name:PROSTICK MOBILE LABS LLC
Entity type:Organization
Organization Name:PROSTICK MOBILE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMINO
Authorized Official - Suffix:
Authorized Official - Credentials:PBT
Authorized Official - Phone:817-933-2394
Mailing Address - Street 1:5909 SHORT CAKE LN
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-6402
Mailing Address - Country:US
Mailing Address - Phone:817-933-2394
Mailing Address - Fax:817-549-7848
Practice Address - Street 1:5909 SHORT CAKE LN
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-6402
Practice Address - Country:US
Practice Address - Phone:817-933-2394
Practice Address - Fax:817-549-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty