Provider Demographics
NPI:1194835033
Name:ORDONEZ, ANDRES (PA)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:ORDONEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14013 LA CASCADA CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8356
Mailing Address - Country:US
Mailing Address - Phone:661-587-6585
Mailing Address - Fax:
Practice Address - Street 1:9900 STOCKDALE HWY STE 107
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3633
Practice Address - Country:US
Practice Address - Phone:661-664-0600
Practice Address - Fax:661-664-0621
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17856363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00072073OtherMEDICARE RAILROAD
CAPA178560Medicaid
CAOPA178560Medicare PIN
CAPA178560Medicaid