Individual
OMAR GANDARILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17214 SE DIVISION ST, PORTLAND, OR 97236-1282
(503) 761-5272
(503) 762-6250
Mailing address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
12/04/2014
Last updated
12/04/2014
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