Provider Demographics
| NPI: | 1457179335 |
|---|---|
| Name: | DLG MOBILE LAB SERVICES INC |
| Entity type: | Organization |
| Organization Name: | DLG MOBILE LAB SERVICES INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | AMPARO |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | RODRIGUEZ NIEVES |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHLEBOTOMY |
| Authorized Official - Phone: | 813-812-9868 |
| Mailing Address - Street 1: | 6064 CAUSEWAY BLVD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | TAMPA |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33619-6206 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 813-812-9868 |
| Mailing Address - Fax: | 813-999-1046 |
| Practice Address - Street 1: | 6064 CAUSEWAY BLVD |
| Practice Address - Street 2: | |
| Practice Address - City: | TAMPA |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33619-6206 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 813-812-9868 |
| Practice Address - Fax: | 813-999-1046 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-09-30 |
| Last Update Date: | 2025-05-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
| No | 246RM2200X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Medical Laboratory |
| Yes | 246QL0900X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Laboratory Management |
| No | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
| No | 261QC1800X | Ambulatory Health Care Facilities | Clinic/Center | Corporate Health |
| No | 261QF0050X | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 261QM1000X | Ambulatory Health Care Facilities | Clinic/Center | Migrant Health |
| No | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
| No | 261QP2400X | Ambulatory Health Care Facilities | Clinic/Center | Prison Health |
| No | 291U00000X | Laboratories | Clinical Medical Laboratory | |
| No | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
