Healthcare Provider Details

I. General information

NPI: 1700433604
Provider Name (Legal Business Name): KARLA BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2019
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 TUOLUMNE ST
VALLEJO CA
94590-5700
US

IV. Provider business mailing address

3825 CHAPPARAL DR
FAIRFIELD CA
94534-7930
US

V. Phone/Fax

Practice location:
  • Phone: 707-553-5509
  • Fax: 707-553-5307
Mailing address:
  • Phone: 707-718-8531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: