Healthcare Provider Details

I. General information

NPI: 1578106274
Provider Name (Legal Business Name): VALENTINO BAILEY M.S. ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 N MIAMI AVE APT 515
MIAMI FL
33136-2010
US

IV. Provider business mailing address

1657 N MIAMI AVE APT 515
MIAMI FL
33136-2010
US

V. Phone/Fax

Practice location:
  • Phone: 310-367-7517
  • Fax:
Mailing address:
  • Phone: 310-367-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1060542
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: