Provider Demographics
NPI:1053024976
Name:WALLS PHLEBOTOMY
Entity type:Organization
Organization Name:WALLS PHLEBOTOMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHLEBOTOMIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAREDES
Authorized Official - Suffix:
Authorized Official - Credentials:CPT 1
Authorized Official - Phone:916-741-2944
Mailing Address - Street 1:6050 PLACER WEST DR APT 509
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4614
Mailing Address - Country:US
Mailing Address - Phone:916-741-2944
Mailing Address - Fax:559-478-2706
Practice Address - Street 1:210 ESTATES DR STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2300
Practice Address - Country:US
Practice Address - Phone:916-741-2944
Practice Address - Fax:559-478-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty