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Organization

PHLEBO MOBILE LLC

Active
Other names
Phlebo Mobile LLC
Organization subpart
No

Provider details

NPI number
Authorized official
MISS HEATHER ROSE CHARLIE NCPT (OWNER/ADMINISTRATOR/NCPT)
(505) 330-6953
Entity
Organization

Contact information

Practice address
1305 HUTTON AVE, FARMINGTON, NM 87402-7601
(505) 330-6953
(505) 258-4356
Mailing address
1305 HUTTON AVE, FARMINGTON, NM 87402-7601
(505) 330-6953
(505) 258-4356

Taxonomy

Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1165083
NATIONAL CERTIFIED PHLEBOTOMY TECHNICIAN
NM
01
22-00013318
CITY OF FARMINGTON LICENSE
NM
01
6872409
NEW MEXICO SECRETARY OF STATE CERTIFICATE OF ORGANIZATION
NM
05
76127052
NM
Enumeration date
08/11/2022
Last updated
08/11/2022
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