Provider Demographics
NPI:1215399639
Name:GONZALEZ GALLARDO, KELVIS (MD)
Entity Type:Individual
Prefix:
First Name:KELVIS
Middle Name:
Last Name:GONZALEZ GALLARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-0580
Mailing Address - Country:US
Mailing Address - Phone:559-386-4500
Mailing Address - Fax:559-282-5080
Practice Address - Street 1:148 E KINGS ST
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-1529
Practice Address - Country:US
Practice Address - Phone:559-386-9000
Practice Address - Fax:559-386-9090
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA157046207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine