Healthcare Provider Details

I. General information

NPI: 1649339946
Provider Name (Legal Business Name): DAVID WAYNE BAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEEPER AVENUE
COLTON CA
92324-1819
US

IV. Provider business mailing address

26230 LAWTON AVENUE
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-6315
  • Fax:
Mailing address:
  • Phone: 909-796-1813
  • Fax: 909-796-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG078854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: