Basic Information
| Provider Information | |||||||||
| NPI: | 1518073956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORDONEZ | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | EUSEBIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 S INDEPENDENCE BLVD | ||||||||
| Address2: | STE 6 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234534776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573005129 | ||||||||
| FaxNumber: | 7577944635 | ||||||||
| Practice Location | |||||||||
| Address1: | 1925 GLENN MITCHELL DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234560170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576898430 | ||||||||
| FaxNumber: | 7576898435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101239407 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 237850 | 01 | VA | ANTHEM | OTHER |