Healthcare Provider Details

I. General information

NPI: 1194800052
Provider Name (Legal Business Name): TIMOTHY SILLECK BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CITRACADO PKWY STE 108
ESCONDIDO CA
92025-6428
US

IV. Provider business mailing address

625 W CITRACADO PKWY STE 108 STE 108
ESCONDIDO CA
92025-6428
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-1431
  • Fax: 760-743-6455
Mailing address:
  • Phone: 760-743-1431
  • Fax: 760-743-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG60763
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG60763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: