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General NPI Number Information
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NPI Number | 1699899674
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Entity Type | Individual
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Provider Name | OMAR GABRIEL GUDINO PH.D., ABPP
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 2000 ALAMEDA DE LAS PULGAS STE 242
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City | SAN MATEO
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State | CA
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Zip | 94403-1271
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Country | US
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Telephone | 650-931-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 ALAMEDA DE LAS PULGAS STE 242
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City | SAN MATEO
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State | CA
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Zip | 94403-1271
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Country | US
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Telephone | 650-931-6565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 34415
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 018596
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 018596
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 34415
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License Number State | CA
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