Dr. Manuel E. Gordillo Inc.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

028854 Issued in OH

Legal business name

DR. MANUEL E. GORDILLO INC.

Practice address

30400 Detroit Rd
Suite 304
Westlake, OH 44145-1872

Phone

(440) 835-6189

Fax

(440) 899-4357

NPI assigned

May 22, 2008

Last updated

May 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Manuel E. Gordillo, M.D.

Title

President

Phone

(440) 835-6189

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1801053111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30400 DETROIT RD",
            "address_2": "SUITE 304",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451872",
            "telephone_number": "440-835-6189",
            "fax_number": "440-899-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30400 DETROIT RD",
            "address_2": "SUITE 304",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451872",
            "telephone_number": "440-835-6189",
            "fax_number": "440-899-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MANUEL E. GORDILLO INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2008-05-22",
        "status": "A",
        "authorized_official_last_name": "GORDILLO",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-835-6189",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "OH",
            "license": "028854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0123780",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ID",
            "identifier": "000000126508",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Westlake, OH
• Providers in Westlake, OH by specialty
• Adult Mental Health Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.