Provider Demographics
NPI:1740415371
Name:PICHARDO LAFONTAINE, GABRIELA (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:
Last Name:PICHARDO LAFONTAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 FAR WEST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3187
Mailing Address - Country:US
Mailing Address - Phone:512-717-9775
Mailing Address - Fax:512-599-5034
Practice Address - Street 1:3410 FAR WEST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3187
Practice Address - Country:US
Practice Address - Phone:512-717-9775
Practice Address - Fax:512-599-5034
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205609207R00000X
TXQ3422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1883697Medicaid