Provider Demographics
NPI:1962891440
Name:AHMAD BAILONY MD INC
Entity type:Organization
Organization Name:AHMAD BAILONY MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAILONY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-470-1945
Mailing Address - Street 1:655 EUCLID AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2967
Mailing Address - Country:US
Mailing Address - Phone:619-470-1945
Mailing Address - Fax:619-475-5048
Practice Address - Street 1:655 EUCLID AVE STE 205
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2967
Practice Address - Country:US
Practice Address - Phone:619-470-1945
Practice Address - Fax:619-475-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108665208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA108665Medicaid
CAA34406Medicaid