Healthcare Provider Details

I. General information

NPI: 1740957398
Provider Name (Legal Business Name): MR. LEOPOLDO ANTONIO ORDAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 L ST
BAKERSFIELD CA
93301-4509
US

IV. Provider business mailing address

1304 L ST
BAKERSFIELD CA
93301-4509
US

V. Phone/Fax

Practice location:
  • Phone: 661-634-9877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: