Bianca Cannavo, MCD-CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

12007 Issued in CA

Practice address

1040 Wycliffe
Irvine, CA 92602-1222

Phone

(909) 762-1465

NPI assigned

Feb 7, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Bianca Bustamante Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1972002780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 CONTESSA",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926201726",
            "telephone_number": "909-762-1465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 WYCLIFFE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926021222",
            "telephone_number": "909-762-1465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17875 Von Karman Ave Bldg A",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926146200",
            "country_code": "US",
            "telephone_number": "949-873-6644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNAVO",
        "first_name": "BIANCA",
        "name_prefix": "Mrs.",
        "credential": "MCD-CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-07",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "12007",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "12007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BIANCA",
            "last_name": "BUSTAMANTE",
            "credential": "MCD-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nadia S Campos
• Peter D. Cancellier, D.D.S.
• Cancer Center Imaging Inc. (KSK Imaging Center of Irvine, KSK Breast Center of Irvine)
• Kristin Canedo
• Denise Canellos, MS, CNS
• Julie Lynn Canning, RDH
• Russell Wayne Cannon, D.D.S.
• Tatiana Cannon
• Sena Cantas Orsdemir, MD
• Kristin Canterbury

• Speech-Language Pathologist in Irvine, CA
• Providers in Irvine, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.