Provider Demographics
NPI:1386675833
Name:BAILEY, CALVIN LAMONT (RN)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:LAMONT
Last Name:BAILEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 106 LANGFORD LAKE RD
Mailing Address - Street 2:ROOM 207
Mailing Address - City:FT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-386-3538
Mailing Address - Fax:
Practice Address - Street 1:4TH & INNER LOOP
Practice Address - Street 2:BLDG 166
Practice Address - City:FT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001155641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse