Provider Demographics
NPI:1710532544
Name:GALLARDO, KRISTA ROSE
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ROSE
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 W 104TH PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3651
Mailing Address - Country:US
Mailing Address - Phone:505-977-6861
Mailing Address - Fax:
Practice Address - Street 1:4375 S ELATI ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-5649
Practice Address - Country:US
Practice Address - Phone:720-737-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician