Healthcare Provider Details

I. General information

NPI: 1518894641
Provider Name (Legal Business Name): BAILEY FOXALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

116 W EL PORTAL STE 101
SAN CLEMENTE CA
92672-4634
US

IV. Provider business mailing address

26891 PRECIADOS DR
MISSION VIEJO CA
92691-5237
US

V. Phone/Fax

Practice location:
  • Phone: 949-545-8482
  • Fax:
Mailing address:
  • Phone: 949-545-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: