Healthcare Provider Details

I. General information

NPI: 1679400154
Provider Name (Legal Business Name): LISA MARIE BELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2843 FARMINGTON RD
STOCKTON CA
95205-7845
US

IV. Provider business mailing address

2843 FARMINGTON RD
STOCKTON CA
95205-7845
US

V. Phone/Fax

Practice location:
  • Phone: 209-933-7255
  • Fax:
Mailing address:
  • Phone: 209-933-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: