Provider Demographics
NPI:1609465186
Name:BAILLERES, BIJANA
Entity Type:Individual
Prefix:
First Name:BIJANA
Middle Name:
Last Name:BAILLERES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HAMPSHIRE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2540
Mailing Address - Country:US
Mailing Address - Phone:239-384-2826
Mailing Address - Fax:
Practice Address - Street 1:650 HAMPSHIRE RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2540
Practice Address - Country:US
Practice Address - Phone:239-384-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty