Active NPI
Bryan Bacallao Gardeazab
- Behavior Technician
- Hialeah, FL
National Provider Identifier
1578457198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 25-432675
- Practice address
- 3375 W 76TH St Apt 223
Hialeah, FL 33018-1777 - Phone
- (786) 348-3461
- NPI assigned
- Jun 6, 2025
- Last updated
- Jun 23, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 25-432675 | FL | Primary |
Addresses
Primary practice location
3375 W 76TH St Apt 223
Hialeah, FL 33018-1777
Mailing address
3375 W 76TH St Apt 223
Hialeah, FL 33018-1777
Phone (786) 348-3461
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25-432675 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750636800000",
"number": "1578457198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3375 W 76TH ST APT 223",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330181777",
"telephone_number": "786-348-3461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3375 W 76TH ST APT 223",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330181777",
"telephone_number": "786-348-3461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACALLAO GARDEAZAB",
"first_name": "BRYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-06-06",
"last_updated": "2025-06-23",
"certification_date": "2025-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "25-432675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.