Healthcare Provider Details

I. General information

NPI: 1265802599
Provider Name (Legal Business Name): PATRICIA GALLARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8324 SW 8TH ST
MIAMI FL
33144-4180
US

IV. Provider business mailing address

10012 NW 7TH ST UNIT 209
MIAMI FL
33172-4096
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6868
  • Fax:
Mailing address:
  • Phone: 786-525-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA12924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: