MEDICARE: LUPITA CATRINA GALLARDO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036139803	IL
2	207Q00000X	Family Medicine Physician	ME157471	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215270111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUPITA CATRINA GALLARDO M.D.

Provider Business Mailing Address
First Line	:	2931 ALT 19
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1928
Country	:	US
Telephone Number	:	727-785-2298
Fax Number	:	813-635-7944

Provider Business Practice Location Address
First Line	:	2931 ALT 19
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1928
Country	:	US
Telephone Number	:	727-785-2298
Fax Number	:	813-635-7944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	10/28/2022

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