Active NPI
Andre Gallares, PA-C
- Surgical Physician Assistant
- San Diego, CA
National Provider Identifier
1093018764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA21239
- Practice address
- 6645 Alvarado Rd
Suite 4000
San Diego, CA 92120-5208 - Phone
- (619) 229-4901
- Fax
- (619) 229-4938
- NPI assigned
- Dec 17, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA21239 | CA | Primary |
Addresses
Primary practice location
6645 Alvarado Rd
Suite 4000
San Diego, CA 92120-5208
Mailing address
6645 Alvarado Rd
Suite 4000
San Diego, CA 92120-5208
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA21239 | CA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sharp Memorial Hospital | Past | Accepting new patients | |
| Planned Parenthood of the Pacific Southwest | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/9c14889b-5c15-4fbc-9176-47ac68d769a1/
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community Health Clinic/Center
- San Diego, CA
- NPI 1427081652
-
- Rehabilitation Hospital Unit
- San Diego, CA
- NPI 1114901352
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292544000000",
"number": "1093018764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6645 ALVARADO RD",
"address_2": "SUITE 4000",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921205208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6645 ALVARADO RD",
"address_2": "SUITE 4000",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921205208",
"telephone_number": "619-229-4901",
"fax_number": "619-229-4938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLARES",
"first_name": "ANDRE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-17",
"last_updated": "2010-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "CA",
"license": "PA21239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.