Provider Demographics
NPI:1225100233
Name:BAILEY, BRANDY (MCW II)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MCW II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 BALBOA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6367
Mailing Address - Country:US
Mailing Address - Phone:213-305-3758
Mailing Address - Fax:
Practice Address - Street 1:10605 BALBOA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6367
Practice Address - Country:US
Practice Address - Phone:213-305-3758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner