Provider Demographics
NPI:1083451660
Name:GALLARDO ROCHA, MERCEDES
Entity type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:
Last Name:GALLARDO ROCHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3612
Mailing Address - Country:US
Mailing Address - Phone:541-980-5497
Mailing Address - Fax:
Practice Address - Street 1:1525 W 12TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3612
Practice Address - Country:US
Practice Address - Phone:541-980-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000110520.172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker