Healthcare Provider Details

I. General information

NPI: 1700116605
Provider Name (Legal Business Name): CUAUHTEMOC GALLARDO-PRADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 05/23/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 E SOUTHERN AVE STE 106
MESA AZ
85204-5058
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 480-870-7400
  • Fax: 480-906-2174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number67041
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR71439
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number67041
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: