Individual
BAILEY BANGERTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
220 HOSPITAL DR # A-233, VALLEJO, CA 94589-2517
(707) 641-1900
Mailing address
5621 EL DORADO AVE APT 2, EL CERRITO, CA 94530-3436
(206) 930-5168
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60900605
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1155569
NCCPA
—
01
—
59535
CALIFORNIA PA BOARD
CA
01
—
PA60900605
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
11/26/2018
Last updated
06/29/2021
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