Provider Demographics
NPI:1104175264
Name:GALLARDO, EDITH Y
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:Y
Last Name:GALLARDO
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 1:806 MORGAN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-5141
Mailing Address - Country:US
Mailing Address - Phone:956-428-6800
Mailing Address - Fax:956-440-7401
Practice Address - Street 1:806 MORGAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5141
Practice Address - Country:US
Practice Address - Phone:956-428-6800
Practice Address - Fax:956-440-7401
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211267224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant