Healthcare Provider Details

I. General information

NPI: 1669786174
Provider Name (Legal Business Name): EMILY A LIEUALLEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43658 STATE HIGHWAY 299 E
FALL RIVER MILLS CA
96028-9819
US

IV. Provider business mailing address

PO BOX 490
FALL RIVER MILLS CA
96028-0490
US

V. Phone/Fax

Practice location:
  • Phone: 530-999-9020
  • Fax: 530-362-4068
Mailing address:
  • Phone: 530-999-9020
  • Fax: 530-362-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A25074
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO164168
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: