Provider Demographics
NPI:1154099125
Name:GALLARDO, GIOVANNA DOMINIQUE
Entity Type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:DOMINIQUE
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 LAGO VENTANA
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-2080
Mailing Address - Country:US
Mailing Address - Phone:619-495-0229
Mailing Address - Fax:
Practice Address - Street 1:8344 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1307
Practice Address - Country:US
Practice Address - Phone:858-565-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics