Provider Demographics
NPI:1558033969
Name:GALLARDO, JOSEPH EMMANUEL (NP, FNP-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EMMANUEL
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:NP, FNP-C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4494 W PEORIA AVE STE 115A ROOM 18
Mailing Address - Street 2:STE 115A ROOM 18
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302
Mailing Address - Country:US
Mailing Address - Phone:623-329-8735
Mailing Address - Fax:623-321-7259
Practice Address - Street 1:4494 W PEORIA AVE STE 115A ROOM 18
Practice Address - Street 2:STE 115A ROOM 18
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302
Practice Address - Country:US
Practice Address - Phone:623-329-8735
Practice Address - Fax:623-321-7259
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN196045163WG0000X
AZ276425207R00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine