Provider Demographics
NPI:1750392510
Name:GALLARDO, NILSA V (PSYD)
Entity type:Individual
Prefix:DR
First Name:NILSA
Middle Name:V
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1041 N FORMOSA AVENUE
Mailing Address - Street 2:FORMOSA BUILDING SUITE 5
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:323-934-4399
Mailing Address - Fax:323-850-2638
Practice Address - Street 1:11080 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1937
Practice Address - Country:US
Practice Address - Phone:310-966-6538
Practice Address - Fax:310-231-0684
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16013103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist