1104359546 NPI number — DR. BAILEY MARIA PESTEREV M.D.

Table of content: DR. BAILEY MARIA PESTEREV M.D. (NPI 1104359546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104359546 NPI number — DR. BAILEY MARIA PESTEREV M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PESTEREV
Provider First Name:
BAILEY
Provider Middle Name:
MARIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BONURA
Provider Other First Name:
BAILEY
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104359546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UCLA OB GYN 10833 LE CONTE AVE
Provider Second Line Business Mailing Address:
CHS 27-126
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90095-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-825-9945
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UCLA OB GYN 10833 LE CONTE AVE
Provider Second Line Business Practice Location Address:
CHS 27-126
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-825-9945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)