Provider Demographics
NPI:1679515266
Name:ORDAS, TAMARA (PT, DPT, MPT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:ORDAS
Suffix:
Gender:F
Credentials:PT, DPT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 W BELL RD
Mailing Address - Street 2:STE 1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8545
Mailing Address - Country:US
Mailing Address - Phone:909-824-3918
Mailing Address - Fax:949-861-8601
Practice Address - Street 1:17332 VON KARMAN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6242
Practice Address - Country:US
Practice Address - Phone:949-861-8600
Practice Address - Fax:949-861-8601
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ04462Medicare UPIN