Healthcare Provider Details

I. General information

NPI: 1558033969
Provider Name (Legal Business Name): JOSEPH EMMANUEL GALLARDO NP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W THUNDERBIRD RD STE C2
GLENDALE AZ
85306-4639
US

IV. Provider business mailing address

5620 W THUNDERBIRD RD STE C2
GLENDALE AZ
85306-4639
US

V. Phone/Fax

Practice location:
  • Phone: 623-329-8735
  • Fax: 623-321-7259
Mailing address:
  • Phone: 623-329-8735
  • Fax: 623-321-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number276425
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN196045
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number276425
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: