Provider Demographics
NPI:1518073956
Name:ORDONEZ, ALICE EUSEBIO (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:EUSEBIO
Last Name:ORDONEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7615
Mailing Address - Country:US
Mailing Address - Phone:757-300-1071
Mailing Address - Fax:757-525-2953
Practice Address - Street 1:2712 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7615
Practice Address - Country:US
Practice Address - Phone:757-300-1071
Practice Address - Fax:757-525-2953
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA237850OtherANTHEM
VA237850OtherANTHEM