Provider Demographics
NPI:1043952336
Name:ORDONEZ-ANAZCO, GLENDA SALOME (RD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:SALOME
Last Name:ORDONEZ-ANAZCO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 WARWICK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-2365
Mailing Address - Country:US
Mailing Address - Phone:757-534-6889
Mailing Address - Fax:757-534-5581
Practice Address - Street 1:12100 WARWICK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2365
Practice Address - Country:US
Practice Address - Phone:757-534-6889
Practice Address - Fax:757-534-5581
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered