Provider Demographics
NPI:1528448230
Name:OC HOME PHLEBOTOMY
Entity type:Organization
Organization Name:OC HOME PHLEBOTOMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHLEBOTOMIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-939-6729
Mailing Address - Street 1:41 VIA LAVENDERA
Mailing Address - Street 2:
Mailing Address - City:RSM
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1473
Mailing Address - Country:US
Mailing Address - Phone:949-939-6729
Mailing Address - Fax:
Practice Address - Street 1:41 VIA LAVENDERA
Practice Address - Street 2:
Practice Address - City:RSM
Practice Address - State:CA
Practice Address - Zip Code:92688-1473
Practice Address - Country:US
Practice Address - Phone:949-939-6729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT00053243291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory