Provider Demographics
NPI:1083364947
Name:GARDUNO, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:GARDUNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N LAVENTURE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3901
Mailing Address - Country:US
Mailing Address - Phone:360-814-8240
Mailing Address - Fax:360-848-4502
Practice Address - Street 1:110 N LAVENTURE RD STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3901
Practice Address - Country:US
Practice Address - Phone:360-814-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61670214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine