Provider Demographics
NPI:1366817397
Name:GALLARDO, XIORALYS (MSW)
Entity Type:Individual
Prefix:
First Name:XIORALYS
Middle Name:
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:XIORALYS
Other - Middle Name:
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:300 CAMINO MUNICIPAL PLAZA
Mailing Address - Street 2:APT. 10
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-3140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 CAMINO MUNICIPAL APT 10
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-3140
Practice Address - Country:US
Practice Address - Phone:787-455-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22314104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker