Healthcare Provider Details

I. General information

NPI: 1053746370
Provider Name (Legal Business Name): LIZNAVAL,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HARRIS AVE
RODEO CA
94572-1037
US

IV. Provider business mailing address

200 HARRIS AVE
RODEO CA
94572-1037
US

V. Phone/Fax

Practice location:
  • Phone: 510-620-4255
  • Fax:
Mailing address:
  • Phone: 510-620-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number079200303
License Number StateCA

VIII. Authorized Official

Name: MS. ALICIA OLAGUER NAVAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 510-620-4255