Individual
EVAN BAILY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
199 W PORTAL AVE, SAN FRANCISCO, CA 94127-1305
(415) 821-8798
(415) 242-6244
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
58861
CA
363A00000X
Physician Assistant
PA031462
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA1800038
CONTROLLED SUBSTANCE REGISTRATION
DC
01
—
MA059187
PENNSYLVANIA BOARD OF MEDICINE
PA
01
—
OA004271
PENNSYLVANIA BOARD OF OSTEOPATHIC MEDICINE
PA
Enumeration date
12/22/2015
Last updated
03/07/2023
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