Healthcare Provider Details

I. General information

NPI: 1669951562
Provider Name (Legal Business Name): FLOYD BAILEY RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 WOODMAN AVE BLDG 5
PANORAMA CITY CA
91402
US

IV. Provider business mailing address

15711 ALIA CT
SANTA CLARITA CA
91387-4466
US

V. Phone/Fax

Practice location:
  • Phone: 818-815-6130
  • Fax:
Mailing address:
  • Phone: 561-577-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number33613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: