Organization
DR. MANUEL E. GORDILLO INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANUEL E. GORDILLO M.D. (PRESIDENT)
(440) 835-6189
Entity
Organization
Contact information
Practice address
30400 DETROIT RD, SUITE 304, WESTLAKE, OH 44145-1872
(440) 835-6189
(440) 899-4357
Mailing address
30400 DETROIT RD, SUITE 304, WESTLAKE, OH 44145-1872
(440) 835-6189
(440) 899-4357
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
028854
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000126508
ANTHEM ID
—
05
—
0123780
—
OH
Enumeration date
05/22/2008
Last updated
05/22/2008
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