Provider Demographics
NPI:1437046703
Name:TOLBERT, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 SUISUN VALLEY RD STE E610
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-4016
Mailing Address - Country:US
Mailing Address - Phone:510-295-9100
Mailing Address - Fax:
Practice Address - Street 1:720 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5727
Practice Address - Country:US
Practice Address - Phone:510-295-1000
Practice Address - Fax:866-908-9779
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit