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General NPI Number Information
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NPI Number | 1922823582
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Entity Type | Individual
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Provider Name | BRANDON I ORDONEZ LMSW
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Gender | Male
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 4950 MCNUTT RD
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City | SANTA TERESA
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State | NM
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Zip | 88008-9621
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Country | US
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Telephone | 575-618-7993
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Fax |
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Provider Business Mailing Address
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Address Line | 3038 SAN ELIZARIO CT
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City | LAS CRUCES
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State | NM
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Zip | 88007-1974
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Country | US
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Telephone | 915-487-4302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | M-11407
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License Number State | NM
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