Provider Demographics
NPI:1912603648
Name:KRL PHLEBOTOMIST AND MEDICAL CONCIERGE SERVICE
Entity Type:Organization
Organization Name:KRL PHLEBOTOMIST AND MEDICAL CONCIERGE SERVICE
Other - Org Name:KRL PHLEBOTOMIST AND MEDICAL CONCIERGE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MBG
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:VAANESSA
Authorized Official - Last Name:NICHOLAS ALEXNADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:885-539-9948
Mailing Address - Street 1:PO BOX 246175
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-0119
Mailing Address - Country:US
Mailing Address - Phone:885-539-9948
Mailing Address - Fax:888-553-9994
Practice Address - Street 1:1321 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1673
Practice Address - Country:US
Practice Address - Phone:885-539-9948
Practice Address - Fax:888-553-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health