Individual provider Active NPI

Liza Joy Dalmacio, LCSW

  • Clinical Social Worker
  • Concord, CA
National Provider Identifier
1982982674
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
26132 Issued in CA
Practice address
1420 Willow Pass Rd Ste 200
Concord, CA 94520-5823
Phone
(925) 521-5132
Fax
(925) 646-5754
NPI assigned
Jul 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 26132 CA Primary

Addresses

Primary practice location

1420 Willow Pass Rd Ste 200
Concord, CA 94520-5823

Mailing address

1420 Willow Pass Rd Ste 200
Concord, CA 94520-5823
Phone (925) 521-5132

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130219000277 CA Practitioner - Clinical Social Worker 2062667280 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26132CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Oct 21, 2015 Accepting new patients
Contra Costa County Current Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Contra Costa County CurrentSince Jan 13, 2013 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 21, 2015 Accepting new patients
Contra Costa County CurrentSince Jan 13, 2013 Accepting new patients

Locations

1420 Willow Pass Rd
Ste 110
Concord, CA 94520
Phone (925) 646-5480

1420 Willow Pass Rd
Ste 200
Concord, CA 94520
Phone (925) 521-5150

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

2523 El Portal Dr
Ste 206
San Pablo, CA 94806
Phone (510) 215-3730

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1982982674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 WILLOW PASS RD STE 200",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945205823",
            "telephone_number": "925-521-5132",
            "fax_number": "925-646-5754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 WILLOW PASS RD STE 200",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945205823",
            "telephone_number": "925-521-5132",
            "fax_number": "925-646-5754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALMACIO",
        "first_name": "LIZA",
        "middle_name": "JOY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-28",
        "last_updated": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "26132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

Verify at the official NPI Registry.