Omar Gabriel Gudino, PH.D., ABPP

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

34415 Issued in CA

Practice address

2000 Alameda de Las Pulgas Ste 242
San Mateo, CA 94403-1271

Phone

(650) 931-6565

NPI assigned

Mar 16, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2019 through Jul 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Child Mind Medical Practice, PC

  • Adolescent and Children Mental Health Clinic/Center
  • San Mateo, CA
  • NPI 1134766041
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1699899674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 ALAMEDA DE LAS PULGAS STE 242",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031271",
            "telephone_number": "650-931-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 ALAMEDA DE LAS PULGAS STE 242",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031271",
            "telephone_number": "650-931-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDINO",
        "first_name": "OMAR",
        "middle_name": "GABRIEL",
        "name_prefix": "Dr.",
        "credential": "PH.D., ABPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "34415",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NY",
            "license": "018596",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "018596",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "34415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Robert Grunert, CACT 2215167-2
• Jose Guadalupe
• Marta Vanessa Guandique, M.S.
• Adrian Guardado
• Guadalupe Gudino
• Jessica Guenther
• Diana Marithe Guerra
• Angelique Elizabeth Guerrero
• Moises Elias Guerrero
• Shayndel Guerrero

• Clinical Child & Adolescent Psychologist in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Clinical Child & Adolescent Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.