Provider Demographics
NPI:1366758922
Name:GALLARDO VARELA, JEAN CARLO (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CARLO
Last Name:GALLARDO VARELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8550
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0550
Mailing Address - Country:US
Mailing Address - Phone:787-766-7070
Mailing Address - Fax:787-756-5207
Practice Address - Street 1:1395 SAN RAFAEL APDO 11338
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-766-7070
Practice Address - Fax:787-756-5207
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY3009612081P2900X
PR1810208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine