Liza J Bryant, PA-C
Individual provider Active NPI Physician Assistant · Empire, CA
NPI 1831156041 · NPPES record last updated Jan 16, 2024
Key facts
- NPI
- 1831156041
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 61069 (CA)
- Practice address
- 198 N G Street
Empire, CA 95319 - Phone
- (209) 522-1010
- Fax
- (209) 522-1014
- NPI assigned
- May 1, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NV, CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051223000139 | NV | Practitioner - Physician Assistant | 2466474432 | Reassigns benefits to 2 organizations |
| I20240523000682 | CA | Practitioner - Physician Assistant | 2466474432 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61069 | CA | MD | General Practice Dentistry |
| PA663 | NV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Golden Valley Health Center | Current |
Accepting new patients | |
| Golden Valley Health Centers | Current |
Accepting new patients | |
| Agata-Venger Partnership | Past | Accepting new patients | |
| Golden Valley Health Centers | Past |
Accepting new patients | |
| P3 Medical Group PC | Physician Assistant | Past |
Accepting new patients |
| Golden Valley Health Center | Past | Accepting new patients |
Locations
1910 Customer Care Way
Atwater, CA 95301
Phone (209) 384-6488
1405 California Ave
Dos Palos, CA 93620
Phone (209) 392-2111
13161 Jefferson St
Le Grand, CA 95333
Phone (209) 389-1900
821 Texas Ave
Los Banos, CA 93635
Phone (209) 385-5481
250 Northgate Dr
Ste 102
Manteca, CA 95336
Phone (209) 239-5299
250 Northgate Dr
Manteca, CA 95336
Phone (209) 239-5299
847 W Childs Ave
Ste B
Merced, CA 95341
847 W Childs Ave
Ste A
Merced, CA 95341
Phone (209) 383-7441
847 W Childs Ave
Ste C
Merced, CA 95341
797 W Childs Ave
Merced, CA 95341
Phone (209) 383-5871
3940 Sandpiper Ave
Merced, CA 95340
Phone (209) 381-4104
857 W Childs Ave
Merced, CA 95341
Phone (209) 384-2706
847 W Childs Ave
Merced, CA 95341
Phone (209) 383-7441
1121 Hammond St
Modesto, CA 95351
Phone (209) 576-4437
1114 6th St
Modesto, CA 95354
Phone (209) 576-2845
1500 Florida Ave
Modesto, CA 95350
Phone (209) 571-5071
2101 Tenaya Dr
Modesto, CA 95354
Phone (209) 576-6766
637 Merced St
Newman, CA 95360
Phone (209) 862-0270
200 C St
Patterson, CA 95363
Phone (209) 892-6307
9235 E Broadway St
Planada, CA 95365
Phone (209) 382-0253
4150 Patterson Rd
Riverbank, CA 95367
Phone (209) 863-3900
1200 W Main St
Turlock, CA 95380
Phone (209) 668-5388
2240 W Monte Vista Ave
Turlock, CA 95382
Phone (209) 664-5150
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA663 | NV | |
| Physician Assistant | 363A00000X | 61069 | CA | Yes |
Addresses
Primary practice location
198 N G Street
Empire, CA 95319
Mailing address
6 Pink Dogwood Dr
Las Vegas, NV 89141-6096
Phone (702) 335-0899
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831156041 | Medicaid | NV |
Other providers in Empire, CA
All providers in Empire, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.