Healthcare Provider Details

I. General information

NPI: 1174134944
Provider Name (Legal Business Name): GABRIELA LORENA NAVARRO GALLARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

35 LOMASNEY WAY APT 406
BOSTON MA
02114-1538
US

V. Phone/Fax

Practice location:
  • Phone: 617-725-5799
  • Fax: 617-725-5799
Mailing address:
  • Phone: 787-245-3948
  • Fax: 787-245-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number1026130
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24755
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: