Healthcare Provider Details

I. General information

NPI: 1871708859
Provider Name (Legal Business Name): ANDRE V GALLARDO OTR, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 AMBER VALLEY DR
WHITTIER CA
90604-4051
US

IV. Provider business mailing address

5551 MOSSVALE CIR
HUNTINGTON BEACH CA
92649-4824
US

V. Phone/Fax

Practice location:
  • Phone: 562-943-7125
  • Fax: 562-903-3398
Mailing address:
  • Phone: 714-206-9884
  • Fax: 714-908-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19169
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: