Provider Demographics
NPI:1942929211
Name:GALLARDO, MARIA GUADALUPE (MA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GUADALUPE
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29341 KIMBERLINA RD STE 10229341
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-7617
Mailing Address - Country:US
Mailing Address - Phone:661-758-4029
Mailing Address - Fax:661-758-0891
Practice Address - Street 1:29341 KIMBERLINA RD STE 10229341
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-7617
Practice Address - Country:US
Practice Address - Phone:661-758-4029
Practice Address - Fax:661-758-0891
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical