Healthcare Provider Details

I. General information

NPI: 1578797858
Provider Name (Legal Business Name): MRS. CYNTHIA GALLARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W. JACKMAN STREET
LANCASTER CA
93534
US

IV. Provider business mailing address

9220 E AVENUE Q14
LITTLEROCK CA
93543-4044
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2850
  • Fax: 661-726-2854
Mailing address:
  • Phone: 661-435-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: