Provider Demographics
NPI:1578171898
Name:GALLARDO, JANELLE (OD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3645
Mailing Address - Country:US
Mailing Address - Phone:310-714-6500
Mailing Address - Fax:
Practice Address - Street 1:1801 E TAHQUITZ CANYON WAY STE 200
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7123
Practice Address - Country:US
Practice Address - Phone:800-898-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34581152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist