Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 300961 | NY |
NPI | 1366758922 |
---|---|
Provider Name | Dr. Jean Carlo Gallardo Varela |
First Address | Bronx, NY 10461 |
Second Address | Bronx, NY 10461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2010 |
Last Update Date | 18/02/2020 |