Healthcare Provider Details

I. General information

NPI: 1083196745
Provider Name (Legal Business Name): ORDONEZ MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 E 8TH ST
NATIONAL CITY CA
91950-2913
US

IV. Provider business mailing address

PO BOX 720951
SAN DIEGO CA
92172-0951
US

V. Phone/Fax

Practice location:
  • Phone: 619-470-6700
  • Fax: 619-839-3663
Mailing address:
  • Phone: 866-284-2771
  • Fax: 800-334-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA82638
License Number StateCA

VIII. Authorized Official

Name: NELDA ORDONEZ
Title or Position: OWNER
Credential: MD
Phone: 619-470-6700