Odalys Castellon PA

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

ODALYS CASTELLON PA

Practice address

3449 Johnson St
Hollywood, FL 33021-5420

Phone

(954) 338-8255

Fax

(954) 963-8121

NPI assigned

Jul 24, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Wanda Lynn Ditthardt

Title

Office Manager

Phone

(954) 964-4113

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343088000000",
    "number": "1689920977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3449 JOHNSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215420",
            "telephone_number": "954-338-8255",
            "fax_number": "954-963-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3449 JOHNSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215420",
            "telephone_number": "954-338-8255",
            "fax_number": "954-963-8121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODALYS CASTELLON PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-24",
        "last_updated": "2012-07-24",
        "status": "A",
        "authorized_official_last_name": "DITTHARDT",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "954-964-4113",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic and Reconstructive Surgery Physician in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Plastic and Reconstructive Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.