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General NPI Number Information
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NPI Number | 1619282985
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Entity Type | Individual
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Provider Name | XITLALICHOMIHA O'DELL DO
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Gender | Female
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 04/18/2015
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Provider Practice Location Address
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Address Line | 373 S WHITE HORSE PIKE
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City | HAMMONTON
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State | NJ
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Zip | 08037-1135
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Country | US
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Telephone | 609-704-0185
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Fax | 609-704-0195
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Provider Business Mailing Address
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Address Line | 373 S WHITE HORSE PIKE
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City | HAMMONTON
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State | NJ
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Zip | 08037-1135
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Country | US
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Telephone | 609-704-0185
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Fax | 609-704-0195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB09203900
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License Number State | NJ
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