Provider Demographics
NPI:1811735798
Name:ORDONIO, JERELL (MT)
Entity type:Individual
Prefix:
First Name:JERELL
Middle Name:
Last Name:ORDONIO
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:9150 CHESAPEAKE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1097
Mailing Address - Country:US
Mailing Address - Phone:619-277-2451
Mailing Address - Fax:
Practice Address - Street 1:9150 CHESAPEAKE DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1097
Practice Address - Country:US
Practice Address - Phone:619-277-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80361225700000X
CA20210171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20210OtherACUPUNCTURE