Healthcare Provider Details

I. General information

NPI: 1992412696
Provider Name (Legal Business Name): LIZA ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 EMPIRE ST
FAIRFIELD CA
94533-5702
US

IV. Provider business mailing address

801 EMPIRE ST
FAIRFIELD CA
94533-5702
US

V. Phone/Fax

Practice location:
  • Phone: 707-425-5744
  • Fax: 707-425-5162
Mailing address:
  • Phone: 707-425-5744
  • Fax: 707-425-5162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW125137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: