Healthcare Provider Details

I. General information

NPI: 1902710098
Provider Name (Legal Business Name): BAILEY COLE HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10087 TERRA LOMA DR
RANCHO CORDOVA CA
95670-3202
US

IV. Provider business mailing address

8808 SAWTELLE WAY APT D
SACRAMENTO CA
95826-2164
US

V. Phone/Fax

Practice location:
  • Phone: 916-848-2671
  • Fax:
Mailing address:
  • Phone: 951-706-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN744095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: