Healthcare Provider Details

I. General information

NPI: 1700815677
Provider Name (Legal Business Name): SALLY J BAILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12677 ALCOSTA RD STE 500
SAN RAMON CA
94583
US

IV. Provider business mailing address

370 N. WIDGET LANE SUITE 210
WALNUT CREEK CA
94598-2452
US

V. Phone/Fax

Practice location:
  • Phone: 925-327-1450
  • Fax: 925-327-1454
Mailing address:
  • Phone: 925-935-6252
  • Fax: 925-935-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number0101239697
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberD0102827
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number036032
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: