Provider Demographics
NPI:1376685685
Name:MARIANO, HIPOLITO GALLARDO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HIPOLITO
Middle Name:GALLARDO
Last Name:MARIANO
Suffix:JR
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 1:3121 E OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-1030
Mailing Address - Country:US
Mailing Address - Phone:559-412-4927
Mailing Address - Fax:559-493-5028
Practice Address - Street 1:3121 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-1030
Practice Address - Country:US
Practice Address - Phone:559-412-4927
Practice Address - Fax:559-493-5028
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88903208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics