Provider Demographics
NPI:1265845887
Name:ORDONEZ-BAMBINO, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:ORDONEZ-BAMBINO
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 1:1406 MERRIAM AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-2335
Mailing Address - Country:US
Mailing Address - Phone:347-965-9315
Mailing Address - Fax:
Practice Address - Street 1:1406 MERRIAM AVE APT 3G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2335
Practice Address - Country:US
Practice Address - Phone:347-965-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY849511142103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst