Healthcare Provider Details

I. General information

NPI: 1700711264
Provider Name (Legal Business Name): J BARDINA PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 BELLINGHAM AVE APT 3
REVERE MA
02151-4344
US

IV. Provider business mailing address

131 BELLINGHAM AVE APT 3
REVERE MA
02151-4344
US

V. Phone/Fax

Practice location:
  • Phone: 786-282-5645
  • Fax: 786-282-5645
Mailing address:
  • Phone: 786-282-5645
  • Fax: 786-282-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA BARDINA
Title or Position: OWNER
Credential: DNP, AGNP-C
Phone: 786-282-5645