Healthcare Provider Details

I. General information

NPI: 1801114111
Provider Name (Legal Business Name): MOHAMMED RAMI BAILONY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 S DELAWARE ST STE 130
SAN MATEO CA
94403-2394
US

IV. Provider business mailing address

3050 S DELAWARE ST STE 130
SAN MATEO CA
94403-2394
US

V. Phone/Fax

Practice location:
  • Phone: 650-319-8654
  • Fax:
Mailing address:
  • Phone: 650-319-8654
  • Fax: 650-251-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberA120308
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA120308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: