Organization
ODALYS CASTELLON PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WANDA LYNN DITTHARDT (OFFICE MANAGER)
(954) 964-4113
Entity
Organization
Contact information
Practice address
3449 JOHNSON ST, HOLLYWOOD, FL 33021-5420
(954) 338-8255
(954) 963-8121
Mailing address
3449 JOHNSON ST, HOLLYWOOD, FL 33021-5420
(954) 338-8255
(954) 963-8121
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
07/24/2012
Last updated
07/24/2012
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