Healthcare Provider Details

I. General information

NPI: 1386095123
Provider Name (Legal Business Name): LATOYA IESHA SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 SUISUN VALLEY RD STE E
FAIRFIELD CA
94534-4027
US

IV. Provider business mailing address

4160 SUISUN VALLEY RD STE E
FAIRFIELD CA
94534-4027
US

V. Phone/Fax

Practice location:
  • Phone: 707-689-1530
  • Fax:
Mailing address:
  • Phone: 707-689-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number97609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: