Provider Demographics
NPI:1124815469
Name:GALLARDO ALZATE, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GALLARDO ALZATE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 CLEVELAND DR
Mailing Address - Street 2:
Mailing Address - City:TOWN OF TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1002
Mailing Address - Country:US
Mailing Address - Phone:646-243-2847
Mailing Address - Fax:
Practice Address - Street 1:604 ELMWOOD AVENUE SUITE G-7654, BOX 601G
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program