Provider Demographics
NPI:1538666714
Name:GALLARDO, RAFAEL ALFONSO (CRT)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ALFONSO
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13230 SW 132ND AVE STE 29
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6144
Mailing Address - Country:US
Mailing Address - Phone:786-554-9115
Mailing Address - Fax:305-424-9194
Practice Address - Street 1:13230 SW 132ND AVE STE 29
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6144
Practice Address - Country:US
Practice Address - Phone:786-554-9115
Practice Address - Fax:305-424-9194
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT14882227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified