Healthcare Provider Details

I. General information

NPI: 1154254431
Provider Name (Legal Business Name): GABRIEL BAILON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1225
ORANGE CA
92868-4638
US

IV. Provider business mailing address

546 W WILSON ST APT 4
COSTA MESA CA
92627-2493
US

V. Phone/Fax

Practice location:
  • Phone: 657-565-3259
  • Fax: 833-706-4826
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: