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General NPI Number Information
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NPI Number | 1205059573
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Entity Type | Individual
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Provider Name | JUDY FERNANDEZ-GALLARDO M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 66 CALLE SANTA CRUZ SUITE 508 INSTITUTO SAN PABLO
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City | BAYAMON
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State | PR
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Zip | 00961-7041
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Country | US
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Telephone | 787-269-0059
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Fax | 787-269-6502
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Provider Business Mailing Address
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Address Line | 451 VIA NIZA PASEO DEL MAR
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City | DORADO
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State | PR
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Zip | 00646-4644
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Country | US
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Telephone | 787-278-0132
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Fax | 787-269-6502
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 8850
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License Number State | PR
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