Provider Demographics
NPI:1124122684
Name:BAILON-AGUINALDO, TERESITA (MD)
Entity type:Individual
Prefix:
First Name:TERESITA
Middle Name:
Last Name:BAILON-AGUINALDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESITA
Other - Middle Name:GIMPAYA
Other - Last Name:BAILON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4867 W SUNSET BLVD
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5969
Mailing Address - Country:US
Mailing Address - Phone:323-783-1686
Mailing Address - Fax:
Practice Address - Street 1:4867 W SUNSET BLVD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5969
Practice Address - Country:US
Practice Address - Phone:323-783-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67619207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A676190F91OtherCAL OPTIMA
CA00A676190Medicaid
CA00A676190F91OtherCAL OPTIMA
CA00A676190Medicaid