| NPI | 1063185015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IDESTA RALPH Owner 239-895-7910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy |
| Additional Taxonomies | 207ZB0001X Pathology, Blood Banking & Transfusion Medicine |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2021-07-27 |