Healthcare Provider Details

I. General information

NPI: 1407482334
Provider Name (Legal Business Name): LAURA JULIANA BARDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAURA JULIANA GODINEZ

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17876 SAINT CLAIR AVE
CLEVELAND OH
44110-2602
US

IV. Provider business mailing address

17876 SAINT CLAIR AVE
CLEVELAND OH
44110-2602
US

V. Phone/Fax

Practice location:
  • Phone: 162-383-3738
  • Fax:
Mailing address:
  • Phone: 216-383-3738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number35.151036
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number35.151036
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: