Provider Demographics
NPI:1871235895
Name:SANTOS ORDONEZ, HERMAN JAVIER (MD)
Entity type:Individual
Prefix:
First Name:HERMAN
Middle Name:JAVIER
Last Name:SANTOS ORDONEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2805
Mailing Address - Country:US
Mailing Address - Phone:203-690-8340
Mailing Address - Fax:
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-688-1734
Practice Address - Fax:475-246-9106
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2025-07-15
Deactivation Date:2023-01-03
Deactivation Code:
Reactivation Date:2023-01-05
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT81127208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program