Provider Demographics
NPI:1619282985
Name:O'DELL, XITLALICHOMIHA (DO)
Entity Type:Individual
Prefix:DR
First Name:XITLALICHOMIHA
Middle Name:
Last Name:O'DELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:XITLALICHOMIHA
Other - Middle Name:
Other - Last Name:GARCIA MUNIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:373 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1135
Mailing Address - Country:US
Mailing Address - Phone:609-704-0185
Mailing Address - Fax:609-704-0195
Practice Address - Street 1:373 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1135
Practice Address - Country:US
Practice Address - Phone:609-704-0185
Practice Address - Fax:609-704-0195
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09203900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine