Provider Demographics
NPI:1871844282
Name:GALLARDO, CLAUDIA BERENICE
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:BERENICE
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 RED GUM CT
Mailing Address - Street 2:SAME AS ABOVE
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-9354
Mailing Address - Country:US
Mailing Address - Phone:209-558-8187
Mailing Address - Fax:209-558-8918
Practice Address - Street 1:800 SCENIC DR BLDG D
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-277-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator