OMAR GANDARILLA (NPI# 1427455534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427455534 |
| Entity Type | Individual |
| Full Name | OMAR GANDARILLA |
| Practice Address |
17214 Se Division St Portland OR 97236-1282 |
| Mailing Address |
14600 Nw Cornell Rd Portland OR 97229-5442 |
| Practice Telephone | 5037615272 |
| Practice Fax Number | 5037626250 |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2014-12-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers |
| Street Address |
17214 SE DIVISION ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97236-1282 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720220510 | Emily Ritter | Counselor | 17214 Se Division St, Portland, OR 97236-1282 | 2009-03-25 |
| 1013449271 | Grace Schroeder | Counselor | 17214 Se Division St, Portland, OR 97236-1282 | 2017-03-28 |
| 1760923791 | Igwe Waters | Counselor | 17214 Se Division St, Portland, OR 97236-1282 | 2017-03-09 |
| 1780128629 | Sheri Hamilton-mccoy | Counselor | 17214 Se Division St, Portland, OR 97236-1282 | 2016-12-12 |
| 1982158333 | Stefanie Cruz | Counselor | 17214 Se Division St, Portland, OR 97236-1282 | 2016-08-14 |
| 1063862951 | Lauren Mullins | Counselor | 17214 Se Division St, Portland, OR 97236-1282 | 2016-06-21 |
| 1699135517 | Tyesha Maecole Mccool-riley | Counselor | 17214 Se Division St, Portland, OR 97236-1282 | 2016-03-04 |
| 1043682529 | Rebecca Reiss | Counselor | 17214 Se Division St, Portland, OR 97236-1282 | 2015-10-23 |
| 1477923126 | Kari Kriedberg | Social Worker | 17214 Se Division St, Portland, OR 97236-1282 | 2015-10-06 |
| 1609257500 | Sarah Devine | Counselor | 17214 Se Division St, Portland, OR 97236-1282 | 2015-06-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336650357 | Wondmimu Edao Chako | Registered Nurse | 3708 Se 144th Avenue, Portland, OR 97236 | 2017-10-17 |
| 1881142388 | John Ho | Pharmacist | 14700 Se Division St., Portland, OR 97236 | 2016-09-14 |
| 1306392527 | Lori-ann Lima | Nurse Practitioner | Multnomah County Health Department- Mid Cty Health Ctr, 12710 Se Division St, Portland, OR 97236 | 2016-08-28 |
| 1982096202 | Allan Fitzpatrick Beals-gibson | Adult Companion | 15602 Se Division St., Portland, OR 97236 | 2015-02-24 |
| 1386047132 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 3530 Se 136th Ave. #5, Portland, OR 97236 | 2014-10-07 |
| 1356750319 | Kendra Harding | Counselor | 17214 Se Division Street, Portland, OR 97236 | 2014-08-04 |
| 1659790400 | Nghia Tran | Pharmacist | 8438 Se 138th Dr, Portland, OR 97236 | 2014-04-09 |
| 1942623764 | Laurel Katherine Hallock Koppelman | Nurse Practitioner | 12720 Se Division Street, Portland, OR 97236 | 2014-01-30 |
| 1982046249 | Victoria D Lathrop | Massage Therapist | 17221 Se Divistion St S-21, Portland, OR 97236 | 2013-07-26 |
| 1669819694 | Ariann Von Vaughn | Dental Hygienist | 18011 Se Pershing Ct, Portland, OR 97236 | 2013-05-31 |
| Find all providers in zip 97236 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912530643 | Positive Development for Youth and Families, Inc. | Psychologist | 4531 Se Belmont St Ste 110, Portland, OR 97215-1675 | 2020-02-21 |
| 1902440704 | Alicia Hoffman | Psychologist | 1577 Congress St Ste 2, Portland, ME 04102-2169 | 2019-11-05 |
| 1467819631 | Megan Nichols | Psychologist | 2734 Se 29th Ave, Apt B, Portland, OR 97202-1381 | 2016-01-19 |
| 1891043360 | Margaret Arnold Stoeckel | Psychologist | 5041 Se Taylor St, Portland, OR 97215-2624 | 2012-08-15 |
| 1851532139 | Charlene Eickholt | Psychologist | 1405 Ne Broadway, Suite # 200, Portland, OR 97232-1497 | 2009-03-16 |
| 1215081716 | Holly Linn Crossen | Psychologist | 1130 Sw Morrison St Ste 618, Portland, OR 97205-2217 | 2007-01-22 |
| 1972654697 | Nicholas John Ure | Psychologist | 101 Se 12th Ave, Portland, OR 97214-1319 | 2007-01-16 |
| 1528134772 | Marianne Michelle Kabour | Psychologist | 2801 N Gantenbein Ave Fl 3, Portland, OR 97227-1623 | 2006-11-28 |
| 1578588539 | Shirley May Hanson | Psychologist | 7912 Sw 35th Ave, Suite 6, Portland, OR 97219-2427 | 2006-07-12 |
| 1518904457 | Redmond Andrew Reams | Psychologist | 2106 Ne 40th Ave, Portland, OR 97212-5405 | 2006-05-31 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.