Healthcare Provider Details

I. General information

NPI: 1285320101
Provider Name (Legal Business Name): MICHAEL ANTHONY BARDO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 S FAIRFAX AVE
LOS ANGELES CA
90019-4401
US

IV. Provider business mailing address

25745 BARTON RD STE 238
LOMA LINDA CA
92354-3812
US

V. Phone/Fax

Practice location:
  • Phone: 424-258-0124
  • Fax:
Mailing address:
  • Phone: 818-235-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA62011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: