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General NPI Number Information
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NPI Number | 1174735880
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Entity Type | Individual
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Provider Name | CONSTANCE CAMILLE GALLARDO FNP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | HARBOR-UCLA 1000 W. CARSON STREET BLDG N25-ROOM E111
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City | TORRANCE
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State | CA
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Zip | 90502
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Country | US
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Telephone | 310-222-4246
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Fax |
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Provider Business Mailing Address
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Address Line | 16931 BLUEWATER LANE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2926
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Country | US
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Telephone | 562-592-3732
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 159764
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License Number State | CA
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