Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1214 | TX |
N | 222Z00000X | Podiatrist | 1214 | TX |
Y | 224P00000X | Prosthetist | 1214 | TX |
NPI | 1346509940 |
---|---|
Provider Name | Fernando Ordaz |
First Address | San Antonio, TX 78254-4420 |
Second Address | San Antonio, TX 78254-4420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1214 | TEXAS BOARD OF ORTHOTICS AND PROSTHETICS (01) | TX |