Provider Demographics
NPI:1982466520
Name:ONDIEKI, ELVIS
Entity type:Individual
Prefix:
First Name:ELVIS
Middle Name:
Last Name:ONDIEKI
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 1:1330 SAN PEDRO DR NE STE 205F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6749
Mailing Address - Country:US
Mailing Address - Phone:505-595-1200
Mailing Address - Fax:949-864-3634
Practice Address - Street 1:1330 SAN PEDRO DR NE STE 205F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6749
Practice Address - Country:US
Practice Address - Phone:214-598-8634
Practice Address - Fax:949-864-3636
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81978363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health