Provider Demographics
NPI:1447582945
Name:ORDINOLA, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:ORDINOLA
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 1:128 DEERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2412
Mailing Address - Country:US
Mailing Address - Phone:702-353-0657
Mailing Address - Fax:
Practice Address - Street 1:613 CACTUS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3809
Practice Address - Country:US
Practice Address - Phone:702-685-1899
Practice Address - Fax:702-685-1799
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner