Provider Demographics
NPI:1962720649
Name:GUALANDI, ELIZABETH JEAN (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:GUALANDI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:JEAN
Other - Last Name:GUALANDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 6096
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6096
Mailing Address - Country:US
Mailing Address - Phone:541-548-8131
Mailing Address - Fax:541-460-4028
Practice Address - Street 1:1253 NW CANAL BLVD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1334
Practice Address - Country:US
Practice Address - Phone:541-548-8131
Practice Address - Fax:541-460-4028
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1952207P00000X
ORDO170032207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine