Provider Demographics
NPI:1598473803
Name:GALLARDO, CRUZ GABRIELA (IDC)
Entity Type:Individual
Prefix:
First Name:CRUZ
Middle Name:GABRIELA
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9114 KENWOOD DR APT A
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-2229
Mailing Address - Country:US
Mailing Address - Phone:915-502-5211
Mailing Address - Fax:
Practice Address - Street 1:9114 KENWOOD DR APT A
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-2229
Practice Address - Country:US
Practice Address - Phone:915-502-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman