Provider Demographics
NPI:1942850383
Name:JARDELEZA, CAMILLE RAVADILLA (MD PHD FRACS)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:RAVADILLA
Last Name:JARDELEZA
Suffix:
Gender:F
Credentials:MD PHD FRACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:SOUTH AUSTRALIA
Mailing Address - Zip Code:05045
Mailing Address - Country:AU
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 MANNING DR DEPT OF
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4221
Practice Address - Country:US
Practice Address - Phone:919-966-3343
Practice Address - Fax:919-966-7941
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty