Healthcare Provider Details

I. General information

NPI: 1770833352
Provider Name (Legal Business Name): PAUL BAILY KUBIN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 MADISON AVE
CARMICHAEL CA
95608-0602
US

IV. Provider business mailing address

6651 MADISON AVE
CARMICHAEL CA
95608-0602
US

V. Phone/Fax

Practice location:
  • Phone: 916-965-1111
  • Fax: 916-965-5143
Mailing address:
  • Phone: 916-965-1111
  • Fax: 916-965-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: