Active NPI
Brenda Liliana Gandara, PHD
- Clinical Psychologist
- Irvine, CA
National Provider Identifier
1275046385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY31390
- Practice address
- 15615 Alton Pkwy Ste 230
Irvine, CA 92618-7306 - Phone
- (949) 528-6300
- NPI assigned
- Nov 10, 2017
- Last updated
- Oct 5, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY31390 | CA | Primary |
| Rehabilitation Practitioner | 225400000X | CA | ||
| Rehabilitation Practitioner | 225400000X | NU | ||
| Rehabilitation Counselor | 225C00000X | NU |
Addresses
Primary practice location
15615 Alton Pkwy Ste 230
Irvine, CA 92618-7306
Mailing address
15615 Alton Pkwy Ste 230
Irvine, CA 92618-7306
Phone (949) 528-6300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY31390 | CA | MD | Clinical Psychologist |
| 31390 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601856000000",
"number": "1275046385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15615 ALTON PKWY STE 230",
"city": "IRVINE",
"state": "CA",
"postal_code": "926187306",
"telephone_number": "949-528-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15615 ALTON PKWY STE 230",
"city": "IRVINE",
"state": "CA",
"postal_code": "926187306",
"telephone_number": "949-528-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANDARA",
"first_name": "BRENDA",
"middle_name": "LILIANA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-10",
"last_updated": "2020-10-05",
"certification_date": "2020-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY31390",
"primary": true
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "225C00000X",
"taxonomy_group": "",
"desc": "Rehabilitation Counselor",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
- Colleen Marie Galvin, PA NMD DACM PHD
- Kristina Galyon, D.O.
- Karen Ann Games, RN
- Elaine Ai Lian Gan Yong, MD
- Lauren Gancayco, RPE-SLP
- Najma Latif Gandhi, M.D.
- Vishal Dilip Gandhi, PHARM D
- Ganem Chiropractic Professional Corp (Body Pro Chiropractic)
- Ganem Chiropractic Professional Corporation (BodyPro Chiropractic)
- Raymond Emile Ganem, D.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.