1750638037 NPI number — MS. BEATRICE LYNETTE BAILEY NP-C

Table of content: MS. BEATRICE LYNETTE BAILEY NP-C (NPI 1750638037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750638037 NPI number — MS. BEATRICE LYNETTE BAILEY NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
BEATRICE
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750638037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25740 MESA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92404-3074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-881-1683
Provider Business Mailing Address Fax Number:
909-881-4215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 E HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92404-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-881-1683
Provider Business Practice Location Address Fax Number:
909-881-4215
Provider Enumeration Date:
08/06/2012

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: 164W00000X , with the licence number:  F0712247 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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