Provider Demographics
NPI:1023157724
Name:BAYARDO, ANGELICA BAYARDO (MD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:BAYARDO
Last Name:BAYARDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10670 WEXFORD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3940
Mailing Address - Country:US
Mailing Address - Phone:858-499-2600
Mailing Address - Fax:858-621-4022
Practice Address - Street 1:10670 WEXFORD ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3940
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:858-621-4022
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA73920AMedicaid
CAWA73920AMedicaid