Healthcare Provider Details

I. General information

NPI: 1710057708
Provider Name (Legal Business Name): BRADLEY B BAILEY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36485 INLAND VALLEY DRIVE
WILDOMAR CA
90595
US

IV. Provider business mailing address

10755 F SCRIPPS POWAY PRKY BOX 537
SAN DIEGO CA
92131
US

V. Phone/Fax

Practice location:
  • Phone: 951-304-7103
  • Fax: 951-304-7101
Mailing address:
  • Phone: 619-258-6200
  • Fax: 619-258-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG85086
License Number StateCA

VIII. Authorized Official

Name: BRADLEY BENJAMIN BAILEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-258-6200