Provider Demographics
NPI:1558197954
Name:BAILES, EILEEN KELLY (RN)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:KELLY
Last Name:BAILES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 SUNSET BLVD
Mailing Address - Street 2:MAIL STOP #61
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:323-361-3004
Mailing Address - Fax:
Practice Address - Street 1:4560 SUNSET BLVD
Practice Address - Street 2:MAIL STOP #61
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-361-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95275405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse