Healthcare Provider Details

I. General information

NPI: 1588811376
Provider Name (Legal Business Name): JOSELYN BAILEY M D A MED CORP JOSELYN E BAILEY PRESIDENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 TORRANCE BL SUITE 506
TORRANCE CA
90503-4492
US

IV. Provider business mailing address

4305 TORRANCE BL SUITE 506
TORRANCE CA
90503-4492
US

V. Phone/Fax

Practice location:
  • Phone: 310-542-7341
  • Fax: 310-542-7343
Mailing address:
  • Phone: 310-542-7341
  • Fax: 310-542-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC34767
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC34767
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSELYN E BAILEY
Title or Position: MEDICAL DOCTOR OWNER
Credential: MD
Phone: 310-542-7341