Healthcare Provider Details

I. General information

NPI: 1902741101
Provider Name (Legal Business Name): MARISSA ANN ORDUNO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 SISK RD
MODESTO CA
95356-8870
US

IV. Provider business mailing address

212 EL VISTA AVE
MODESTO CA
95354-3008
US

V. Phone/Fax

Practice location:
  • Phone: 209-545-7500
  • Fax:
Mailing address:
  • Phone: 209-585-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: