Individual
SELMAWIT DESTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 CESERY BLVD, JACKSONVILLE, FL 32211-5674
(904) 551-5884
Mailing address
2471 BRITNEY LAKES LN, JACKSONVILLE, FL 32221-3817
(904) 610-9305
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
434849
MI
Other
Enumeration date
07/13/2021
Last updated
07/15/2021
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