Basic Information
| Provider Information | |||||||||
| NPI: | 1730747569 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGNOLI | ||||||||
| FirstName: | BRENDEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | AUD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5755 E RIVER RD APT 3603 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857506729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803588175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 N WYATT DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203245437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2019 | ||||||||
| LastUpdateDate: | 06/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | DA11835 | AZ | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.