Provider Demographics
NPI:1912141136
Name:OMONDI, LUZ EVELYN (MD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:EVELYN
Last Name:OMONDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:EVELYN
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 BLACK ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1200
Mailing Address - Country:US
Mailing Address - Phone:203-579-5000
Mailing Address - Fax:203-579-5113
Practice Address - Street 1:64 BLACK ROCK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1200
Practice Address - Country:US
Practice Address - Phone:203-579-5000
Practice Address - Fax:203-579-5113
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52250207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics