Basic Information
| Provider Information | |||||||||
| NPI: | 1629040472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLARDO | ||||||||
| FirstName: | CARIDAD | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9040 SW 117TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331764349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052533066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3641 S MIAMI AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331334205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058540302 | ||||||||
| FaxNumber: | 3058540308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME80093 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 03631Y | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |