Provider Demographics
NPI:1255684320
Name:ADORNO RONDON, DOLLMARIE
Entity Type:Individual
Prefix:
First Name:DOLLMARIE
Middle Name:
Last Name:ADORNO RONDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E SOUTHERN AVE APT 133
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5037
Mailing Address - Country:US
Mailing Address - Phone:787-678-7134
Mailing Address - Fax:
Practice Address - Street 1:20 E THOMAS RD STE 2200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3133
Practice Address - Country:US
Practice Address - Phone:844-843-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19734101YP2500X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health