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General NPI Number Information
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NPI Number | 1710068903
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Entity Type | Organization
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Legal Business Name | CAMELLIA CLINICAL SERVICES INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 250 N KEPLER RD
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City | DELAND
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State | FL
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Zip | 32724-4712
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Country | US
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Telephone | 386-717-2108
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Fax | 386-736-1321
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Provider Business Mailing Address
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Address Line | 250 N KEPLER RD
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City | DELAND
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State | FL
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Zip | 32724-4712
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Country | US
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Telephone | 386-717-2108
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Fax | 386-626-2380
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AIDA DELCASTILLO
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Credential | M.D.
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Telephone | 386-717-2108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | ME0028096
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License Number State | FL
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