Provider Demographics
NPI:1205059573
Name:FERNANDEZ-GALLARDO, JUDY (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:FERNANDEZ-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 1:451 VIA NIZA
Mailing Address - Street 2:PASEO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4644
Mailing Address - Country:US
Mailing Address - Phone:787-278-0132
Mailing Address - Fax:787-269-6502
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:SUITE 508 INSTITUTO SAN PABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-269-0059
Practice Address - Fax:787-269-6502
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR88502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2956OtherAPS HEALTHCARE PR, INC.
PR82562OtherTRIPLE-S INC.
PR2956OtherAPS HEALTHCARE PR, INC.