MEDICARE: DR. RAFAEL A. GALLARDO MENDEZ 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	207W00000X	Ophthalmology Physician	7071	PR

General Provider Information

NPI Number	:	1255318812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAEL A. GALLARDO MENDEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 362158
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-2158
Country	:	US
Telephone Number	:	787-725-6001
Fax Number	:	787-724-6070

Provider Business Practice Location Address
First Line	:	1449 CALLE AMERICO SALAS
Second Line	:	EDIF. PAVIA II, SUITE 203
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2100
Country	:	US
Telephone Number	:	787-725-6001
Fax Number	:	787-724-6070

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

Provider Enumeration Date	:	12/26/2005
Last Update Date	:	09/12/2014

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