Individual
MARK ANTONIO BARDALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
307 S CENTRAL AVE, LOS ANGELES, CA 90013-1709
(213) 372-5233
Mailing address
12070 TELEGRAPH RD, SANTA FE SPRINGS, CA 90670-3771
(562) 777-7500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
Primary
MPSS-CQILDB
CA
Other
Enumeration date
01/05/2024
Last updated
11/24/2025
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