Provider Demographics
NPI:1629791603
Name:ORDAZ, MARK CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:MARK CHRISTOPHER
Middle Name:
Last Name:ORDAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 89TH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1656
Mailing Address - Country:US
Mailing Address - Phone:877-264-6747
Mailing Address - Fax:
Practice Address - Street 1:1100 NORTHWEST LOOP 410 CASTLE HILLS,
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213
Practice Address - Country:US
Practice Address - Phone:877-264-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician