Basic Information
| Provider Information | |||||||||
| NPI: | 1598373649 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLARDO | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3854 E WELDON AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937033342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592642700 | ||||||||
| FaxNumber: | 5592642767 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 M ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592642700 | ||||||||
| FaxNumber: | 5592642767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2020 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 707134 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.