Healthcare Provider Details

I. General information

NPI: 1477432953
Provider Name (Legal Business Name): STEVEN BAYLESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL DR
WEAVERVILLE CA
96093
US

IV. Provider business mailing address

PO BOX 1605
WEAVERVILLE CA
96093-1605
US

V. Phone/Fax

Practice location:
  • Phone: 530-623-2861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: