Healthcare Provider Details

I. General information

NPI: 1194393017
Provider Name (Legal Business Name): ANGELINA BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 CAMINO DEL RIO S STE 300B
SAN DIEGO CA
92108-3531
US

IV. Provider business mailing address

1011 CAMINO DEL RIO S STE 300B
SAN DIEGO CA
92108-3531
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-3292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT163780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: