Provider Demographics
NPI:1174735708
Name:GALLARDO, ALFONSO ISMAEL (BSW)
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:ISMAEL
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-3209
Mailing Address - Country:US
Mailing Address - Phone:719-369-5888
Mailing Address - Fax:
Practice Address - Street 1:1603 E 11TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-3209
Practice Address - Country:US
Practice Address - Phone:719-369-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker