Provider Demographics
NPI:1891552733
Name:GALLARDO, PAIGE ANDRIA
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ANDRIA
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 1:4918 NORTHRUP DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-3345
Mailing Address - Country:US
Mailing Address - Phone:713-530-5690
Mailing Address - Fax:
Practice Address - Street 1:9235 N HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:MONT BELVIEU
Practice Address - State:TX
Practice Address - Zip Code:77523-7876
Practice Address - Country:US
Practice Address - Phone:281-385-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF02240698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily