Provider Demographics
NPI:1154401149
Name:ADDONIZIO, ORNELLA (MD)
Entity type:Individual
Prefix:
First Name:ORNELLA
Middle Name:
Last Name:ADDONIZIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 CHURN CREEK RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1148
Mailing Address - Country:US
Mailing Address - Phone:530-221-7474
Mailing Address - Fax:530-226-6329
Practice Address - Street 1:2891 CHURN CREEK RD.
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1148
Practice Address - Country:US
Practice Address - Phone:530-221-7474
Practice Address - Fax:530-226-6329
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA543052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A543050Medicaid
CA00A543050Medicaid
CAG25370Medicare UPIN