Provider Demographics
NPI:1467062158
Name:ANDERSON, ONDINE ARQUEZ (LMT)
Entity Type:Individual
Prefix:
First Name:ONDINE
Middle Name:ARQUEZ
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 KINSROW AVE APT 266
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8866
Mailing Address - Country:US
Mailing Address - Phone:410-227-2841
Mailing Address - Fax:
Practice Address - Street 1:1375 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3523
Practice Address - Country:US
Practice Address - Phone:541-683-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25649225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1375OtherBLUE CROSS BLUE SHIELD-PACIFIC SOURCE