Provider Demographics
NPI:1689920977
Name:ODALYS CASTELLON PA
Entity Type:Organization
Organization Name:ODALYS CASTELLON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DITTHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-964-4113
Mailing Address - Street 1:3449 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5420
Mailing Address - Country:US
Mailing Address - Phone:954-338-8255
Mailing Address - Fax:954-963-8121
Practice Address - Street 1:3449 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5420
Practice Address - Country:US
Practice Address - Phone:954-338-8255
Practice Address - Fax:954-963-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty