Healthcare Provider Details

I. General information

NPI: 1558273540
Provider Name (Legal Business Name): LIZA PRIMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 GATEWAY PARK BLVD APT 218
SACRAMENTO CA
95834-2404
US

IV. Provider business mailing address

4451 GATEWAY PARK BLVD APT 218
SACRAMENTO CA
95834-2404
US

V. Phone/Fax

Practice location:
  • Phone: 571-206-8177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRIAN CONGELLIERE
Title or Position: OWNER
Credential:
Phone: 571-206-8177