Healthcare Provider Details

I. General information

NPI: 1619910528
Provider Name (Legal Business Name): LAUREL BAILEY MARTINI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20072 SW BIRCH ST FL 2
NEWPORT BEACH CA
92660-0794
US

IV. Provider business mailing address

20072 SW BIRCH ST FL 2
NEWPORT BEACH CA
92660-0794
US

V. Phone/Fax

Practice location:
  • Phone: 888-747-0888
  • Fax:
Mailing address:
  • Phone: 888-747-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A25318
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number43849
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: