Healthcare Provider Details

I. General information

NPI: 1487742425
Provider Name (Legal Business Name): SUSAN A, BAILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA ST STE 201
SAN FRANCISCO CA
94110-4420
US

IV. Provider business mailing address

1580 VALENCIA ST STE 201
SAN FRANCISCO CA
94110-4420
US

V. Phone/Fax

Practice location:
  • Phone: 415-550-4711
  • Fax: 415-282-6703
Mailing address:
  • Phone: 415-550-4711
  • Fax: 415-282-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG29612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: