Healthcare Provider Details

I. General information

NPI: 1992624514
Provider Name (Legal Business Name): MICHELLE GALLARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 W SOUTHERN AVE STE 8
TEMPE AZ
85282-4244
US

IV. Provider business mailing address

3993 N 3RD AVE UNIT 185
PHOENIX AZ
85013-3504
US

V. Phone/Fax

Practice location:
  • Phone: 480-327-6320
  • Fax:
Mailing address:
  • Phone: 505-804-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW22993
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: