Provider Demographics
NPI:1932096401
Name:ORDONEZ, VIVIANE LIZA
Entity type:Individual
Prefix:
First Name:VIVIANE
Middle Name:LIZA
Last Name:ORDONEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 BARTEE AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-4513
Mailing Address - Country:US
Mailing Address - Phone:818-470-3914
Mailing Address - Fax:
Practice Address - Street 1:4955 ALTA ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2452
Practice Address - Country:US
Practice Address - Phone:805-791-3725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program