Provider Demographics
NPI:1710919279
Name:ORDONEZ, DARLITO ALAVA
Entity Type:Individual
Prefix:MR
First Name:DARLITO
Middle Name:ALAVA
Last Name:ORDONEZ
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 1:9136 WAUKEGAN ROAD
Mailing Address - Street 2:UNIT B
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1749
Mailing Address - Country:US
Mailing Address - Phone:847-966-7260
Mailing Address - Fax:847-966-7270
Practice Address - Street 1:9136B WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2119
Practice Address - Country:US
Practice Address - Phone:847-966-7260
Practice Address - Fax:847-966-7270
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205105647001Medicaid
IL205105647001Medicaid