# CAMELLIA CITY OBSTETRICS AND GYNECOLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184634040
- **Authorized official:** DR. DIANA CLAVIN MD (AUTHORIZED AGENT)
- **Authorized official phone:** (985) 781-4848

## Contact information

- **Practice address:** 1150 ROBERT BLVD, SUITE 360, SLIDELL, LA 70458-2004
- **Practice address phone:** (985) 781-4848
- **Practice address fax:** (985) 781-4850
- **Mailing address:** 1150 ROBERT BLVD, SUITE 360, SLIDELL, LA 70458-2004
- **Mailing address phone:** (985) 781-4848
- **Mailing address fax:** (985) 781-4850

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 90577 | LA | Yes |

## Other

- **Enumeration date:** 08/09/2006
- **Last updated:** 02/24/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2113381 | — | LA |
| 01 | — | 5U504DS23 | MEDICARE LA LINKING NO. - ANN R. LOBELLO, MD | LA |
| 01 | — | 5W897DS23 | MEDICARE LA LINKING NO. DIANA K. CLAVIN, MD | LA |