10D0917821 CLIA NUMBER - GEORGE IDICULLA MD

Laboratory Demographics

  • CLIA Code: 10D0917821
  • Facility Name: GEORGE IDICULLA MD
  • Facility Address: 1029 SOUTH FLORIDA AVE
    ROCKLEDGE, FL
    ZIP 32955
  • Facility Phone: 321 638-0888
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GEORGE IDICULLA
  • NPI Number: 1891806642
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0917821
LAB Type Physician Office
Facility Name GEORGE IDICULLA MD
Street 1029 SOUTH FLORIDA AVE
City ROCKLEDGE
State FL
ZIP 32955
Phone 321 638-0888
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/26/2024
Certificate Expiration Date 7/25/2026
Facility Type Physician Office
Lab Director GEORGE IDICULLA

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This page was last updated on: 9/29/2025