Provider Demographics
NPI:1295843977
Name:BAILEY, JOSELYN E (MD)
Entity Type:Individual
Prefix:
First Name:JOSELYN
Middle Name:E
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 TORRANCE BL
Mailing Address - Street 2:SUITE 506
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4492
Mailing Address - Country:US
Mailing Address - Phone:310-542-7341
Mailing Address - Fax:310-542-7343
Practice Address - Street 1:4305 TORRANCE BL
Practice Address - Street 2:SUITE 506
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4492
Practice Address - Country:US
Practice Address - Phone:310-542-7341
Practice Address - Fax:310-542-7343
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34767207RN0300X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C347670Medicaid
CA00C347670Medicaid
CAC34767Medicare PIN