Provider Demographics
NPI:1457022949
Name:BAYARDO, BRIANNA ISABEL
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ISABEL
Last Name:BAYARDO
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 1:1804 VIA DEL SOL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4958
Mailing Address - Country:US
Mailing Address - Phone:505-500-5463
Mailing Address - Fax:
Practice Address - Street 1:454 CORONADO ST NE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8709
Practice Address - Country:US
Practice Address - Phone:505-866-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CF7502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist