Healthcare Provider Details

I. General information

NPI: 1023300795
Provider Name (Legal Business Name): HENRY BAYLIS, M.D. PROCEDURE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AVOCADO AVE 605
NEWPORT BEACH CA
92660-7720
US

IV. Provider business mailing address

1401 AVOCADO AVE 605
NEWPORT BEACH CA
92660-7720
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-0700
  • Fax: 949-760-9017
Mailing address:
  • Phone: 949-760-0700
  • Fax: 949-760-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberC25406
License Number StateCA

VIII. Authorized Official

Name: HENRY I BAYLIS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 949-760-0700