Basic Information
| Provider Information | |||||||||
| NPI: | 1578171898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLARDO | ||||||||
| FirstName: | JANELLE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 N ROOSEVELT AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911073645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107146500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 E TAHQUITZ CANYON WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922627123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008982020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2020 | ||||||||
| LastUpdateDate: | 07/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 34581 | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.