Provider Demographics
NPI:1831540020
Name:GALLARDO-DEFRANCO, ELIZABETH (RD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:GALLARDO-DEFRANCO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-2915
Mailing Address - Country:US
Mailing Address - Phone:323-360-5955
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3906
Practice Address - Country:US
Practice Address - Phone:323-360-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1072722133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered