MEDICARE: DR. LEONARDO ALFONSO GARDUNO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A33758	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528138336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARDO ALFONSO GARDUNO M.D.

Provider Business Mailing Address
First Line	:	519 EAST BROADWAY
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205
Country	:	US
Telephone Number	:	818-409-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	437 S PACIFIC AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1441
Country	:	US
Telephone Number	:	818-241-1500
Fax Number	:	818-241-3500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	10/31/2018

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