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General NPI Number Information
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NPI Number | 1902917305
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Entity Type | Individual
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Provider Name | RENIE BAILYN
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 165 E LINCOLN AVE
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City | ESCONDIDO
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State | CA
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Zip | 92026-3037
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Country | US
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Telephone | 760-908-7066
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Fax |
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Provider Business Mailing Address
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Address Line | 3897 PARK DR
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City | CARLSBAD
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State | CA
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Zip | 92008-2740
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 38028
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License Number State | CA
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