Provider Demographics
NPI:1275094914
Name:CORDERO GALLARDO, GABRIELLA MARIA (DMD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:MARIA
Last Name:CORDERO GALLARDO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 AVE. PONCE DE LEON
Mailing Address - Street 2:TORRE 900 APT.994
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-5073
Mailing Address - Country:US
Mailing Address - Phone:787-422-6861
Mailing Address - Fax:
Practice Address - Street 1:JESUS M. FRAGOSO AVE
Practice Address - Street 2:ES3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-757-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33401223P0300X, 122300000X
MADN1859124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist