Provider Demographics
NPI:1336427939
Name:GUEVARA, SALVADOR GALLARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:GALLARDO
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SALVADOR G.
Other - Middle Name:
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2345 COUNTRY HILLS DR # 100
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-7319
Mailing Address - Country:US
Mailing Address - Phone:925-418-0282
Mailing Address - Fax:925-978-0991
Practice Address - Street 1:3003 OAK RD STE 104
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597
Practice Address - Country:US
Practice Address - Phone:925-391-2220
Practice Address - Fax:925-391-2221
Is Sole Proprietor?:No
Enumeration Date:2011-07-30
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA059593208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery