Provider Demographics
NPI:1932516614
Name:GALLARDO, RONALD ROBERT
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ROBERT
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 W WEBER AVE
Mailing Address - Street 2:STE. 130
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-3151
Mailing Address - Country:US
Mailing Address - Phone:209-644-4823
Mailing Address - Fax:209-932-9446
Practice Address - Street 1:445 W WEBER AVE
Practice Address - Street 2:STE. 130
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-3151
Practice Address - Country:US
Practice Address - Phone:209-644-4823
Practice Address - Fax:209-932-9446
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)