Provider Demographics
NPI:1972326213
Name:BARDON, MONICA CZAJA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:CZAJA
Last Name:BARDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 TRAMWAY BLVD NE APT 153
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6286
Mailing Address - Country:US
Mailing Address - Phone:505-908-4813
Mailing Address - Fax:
Practice Address - Street 1:2700 VISTA GRANDE DR NW UNIT 32
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1039
Practice Address - Country:US
Practice Address - Phone:505-433-8938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician