Healthcare Provider Details

I. General information

NPI: 1174654040
Provider Name (Legal Business Name): ANTONIO JOSE GALLARDO MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 22 BLOQUE 51 #63 SANTA ROSA
BAYAMON PR
00959
US

IV. Provider business mailing address

STREET 22 BLOCK 51 #63 SANTA ROSA
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-4346
  • Fax: 787-780-4576
Mailing address:
  • Phone: 787-780-4346
  • Fax: 787-780-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number6693
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: