Provider Demographics
NPI:1649429861
Name:GALLARDO, ERIC MANUEL (ACNP)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MANUEL
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ASHLAND AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5439
Mailing Address - Country:US
Mailing Address - Phone:310-396-3459
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST # 7
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2527
Practice Address - Fax:310-782-1820
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18418363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care