Doctor Name: | TERENA D GIMMILLARO |
NPI Number: | 1235574955 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DO |
License Number: | |
Business Practice Address: | 16180 Se Sunnyside Rd Suite 105 Happy Valley, OR - 970156301 |
Business Phone Number: | 5035824900 |
Business Fax Number: | |
Mailing Address: | Po Box 3158, PORTLAND |
State: | OR |
Postal Code: | 972083158 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/08/2013 |
NPI Last Update Date: | 09/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OR |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |