Basic Information
| Provider Information | |||||||||
| NPI: | 1942850383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARDELEZA | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | RAVADILLA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD PHD FRACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 749 | ||||||||
| Address2: | |||||||||
| City: | GLENELG | ||||||||
| State: | SOUTH AUSTRALIA | ||||||||
| PostalCode: | 05045 | ||||||||
| CountryCode: | AU | ||||||||
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| Practice Location | |||||||||
| Address1: | 170 MANNING DR DEPT OF | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199663343 | ||||||||
| FaxNumber: | 9199667941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2019 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.