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Individual

IDESTA RALPH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
5530 OLD NATIONAL HWY BLDG 5530-B2, COLLEGE PARK, GA 30349-3356
(470) 818-2264
(866) 984-3729
Mailing address
5530 OLD NATIONAL HWY BLDG 5530-B2, COLLEGE PARK, GA 30349-6234
(470) 818-2264
(866) 984-3729

Taxonomy

Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
56083
NY

Other

Enumeration date
08/14/2014
Last updated
10/16/2024
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