Provider Demographics
NPI:1164652020
Name:BAILEY, SEAN M
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555341
Mailing Address - Street 2:1ST MARINE SPECIAL OPERATIONS BATTALION
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5341
Mailing Address - Country:US
Mailing Address - Phone:949-842-9866
Mailing Address - Fax:
Practice Address - Street 1:519 ORCHID LN
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-8655
Practice Address - Country:US
Practice Address - Phone:949-842-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman