Provider Demographics
NPI:1144366808
Name:BAILEY, TRACEY LEIGH (OMD, LAC)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LEIGH
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 N PROSPECT AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3028
Mailing Address - Country:US
Mailing Address - Phone:310-318-2225
Mailing Address - Fax:310-406-2242
Practice Address - Street 1:510 N PROSPECT AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3028
Practice Address - Country:US
Practice Address - Phone:310-318-2225
Practice Address - Fax:310-406-2242
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3211171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist