Healthcare Provider Details

I. General information

NPI: 1659185585
Provider Name (Legal Business Name): CARLISE MONIQUE BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E RINCON ST STE 209
CORONA CA
92879-1379
US

IV. Provider business mailing address

10320 KITE CT
MORENO VALLEY CA
92557-2762
US

V. Phone/Fax

Practice location:
  • Phone: 562-821-1491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number106S00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: