Healthcare Provider Details

I. General information

NPI: 1366758922
Provider Name (Legal Business Name): JEAN CARLO GALLARDO VARELA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 09/07/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 SAN RAFAEL APDO 11338
SAN JUAN PR
00910
US

IV. Provider business mailing address

PO BOX 8550
SAN JUAN PR
00910-0550
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-7070
  • Fax: 787-756-5207
Mailing address:
  • Phone: 787-766-7070
  • Fax: 787-756-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number300961
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number1810
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: