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General NPI Number Information
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NPI Number | 1346460094
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Entity Type | Individual
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Provider Name | DIANA M. GALLARDO DMD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CARR 156 KM .59.6 CALLE BETANCES FINAL EDIF PUIG SUITE #2
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-744-0600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9508
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City | CAGUAS
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State | PR
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Zip | 00726-9508
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Country | US
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Telephone | 787-744-0600
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1859
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License Number State | PR
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