Provider Demographics
NPI:1235252503
Name:GALLARDO, SANDRA VERONICA
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:VERONICA
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:VERONICA
Other - Last Name:CUELLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:513 E. LA VERNE AVENUE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-623-8150
Mailing Address - Fax:
Practice Address - Street 1:513 E LA VERNE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2809
Practice Address - Country:US
Practice Address - Phone:909-623-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 224012164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse