Provider Demographics
NPI:1932298577
Name:GALLARDO, BESSIE LUNA (MD)
Entity Type:Individual
Prefix:DR
First Name:BESSIE
Middle Name:LUNA
Last Name:GALLARDO
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 1:12751 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5800
Mailing Address - Country:US
Mailing Address - Phone:714-636-7852
Mailing Address - Fax:714-636-0928
Practice Address - Street 1:12751 HARBOR BOULEVARD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5800
Practice Address - Country:US
Practice Address - Phone:714-636-7852
Practice Address - Fax:714-636-0928
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A478060Medicaid
F11452Medicare UPIN
WA47806BMedicare ID - Type Unspecified