Provider Information for 1235601691
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PRISCILLA YVONNE BAYOLA
Sex: Female
NPI: 1235601691
Last Updated: 2020-03-19
Certification Date: 2020-03-19
Certification Date: 2020-03-19
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1235601691 | ||||||||
| Enumeration Date | 2018-12-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 175 E HAWTHORN PKWY STE 235 VERNON HILLS, IL 60061-1454 United States Phone: 478-683-4358 | Fax:847-859-5885 | ||||||||
| Primary Practice Address | 4100 SPRING VALLEY RD STE 515 DALLAS, TX 75244-3629 United States Phone: 817-751-7802 | Fax:847-859-5885 | ||||||||
| Secondary Practice Address(es) | 3117 LANDOVER DR 8915 HARRY HINES BLVD | ||||||||
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