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General NPI Number Information
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NPI Number | 1184634040
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Entity Type | Organization
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Legal Business Name | CAMELLIA CITY OBSTETRICS AND GYNECOLOGY
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 1150 ROBERT BLVD SUITE 360
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City | SLIDELL
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State | LA
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Zip | 70458-2004
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Country | US
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Telephone | 985-781-4848
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Fax | 985-781-4850
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Provider Business Mailing Address
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Address Line | 1150 ROBERT BLVD SUITE 360
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City | SLIDELL
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State | LA
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Zip | 70458-2004
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Country | US
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Telephone | 985-781-4848
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Fax | 985-781-4850
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | DR. DIANA CLAVIN
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Credential | MD
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Telephone | 985-781-4848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 90577
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License Number State | LA
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