Provider Demographics
NPI:1194589796
Name:OPTIVENA MOBILE PHLEBOTOMY, LLC
Entity type:Organization
Organization Name:OPTIVENA MOBILE PHLEBOTOMY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-692-0527
Mailing Address - Street 1:PO BOX 9518
Mailing Address - Street 2:
Mailing Address - City:CHANDLER HEIGHTS
Mailing Address - State:AZ
Mailing Address - Zip Code:85127-9518
Mailing Address - Country:US
Mailing Address - Phone:602-345-1353
Mailing Address - Fax:
Practice Address - Street 1:22850 EAST MARSH ROAD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:602-345-1353
Practice Address - Fax:623-223-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory