Healthcare Provider Details

I. General information

NPI: 1902731847
Provider Name (Legal Business Name): WELLNESS EMERGING MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CAMINO DIABLO STE 200
WALNUT CREEK CA
94597-3993
US

IV. Provider business mailing address

2900 CAMINO DIABLO STE 200
WALNUT CREEK CA
94597-3993
US

V. Phone/Fax

Practice location:
  • Phone: 415-310-3037
  • Fax: 925-504-0528
Mailing address:
  • Phone:
  • Fax: 925-504-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA FRANCES ELIASER LISKIN
Title or Position: OWNER
Credential: NP
Phone: 415-310-3037