Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | TCH181399 | CA |
NPI | 1255904405 |
---|---|
Provider Name | Annette Gallardo |
First Address | Perris, CA 92571-2607 |
Second Address | Perris, CA 92571-2607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |