Basic Information
| Provider Information | |||||||||
| NPI: | 1932833761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORDONIO | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | WYATT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 ARLINGTON AVE APT 94 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925063241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513008291 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9890 COUNTY FARM RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103377950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2022 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | 175T00000X | Y |
No ID Information.