Healthcare Provider Details

I. General information

NPI: 1891322640
Provider Name (Legal Business Name): KATHERINE BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13652 CANTARA ST BLDG 4
PANORAMA CITY CA
91402-5423
US

IV. Provider business mailing address

13652 CANTARA ST BLDG 4
PANORAMA CITY CA
91402-5423
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number184692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: