Provider Demographics
NPI:1588398739
Name:LEITH, BAILEY MARIE (RADT, RAC)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:MARIE
Last Name:LEITH
Suffix:
Gender:F
Credentials:RADT, RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 E LEMON DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2339
Mailing Address - Country:US
Mailing Address - Phone:805-443-3351
Mailing Address - Fax:
Practice Address - Street 1:749 E LEMON DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2339
Practice Address - Country:US
Practice Address - Phone:805-443-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program