Individual provider · Type 1 NPI
Colleen Ann Ly, PA-C
Surgical Physician Assistant · San Diego, CA
NPI number
1184404261
Active
Practice location
4060 Fourth Ave Ste 700
San Diego, CA 92103-2121
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | PA63447 (CA) |
| Surgical Physician Assistant Primary | 363AS0400X | PA63447 (CA) |
Surgical Physician Assistant: Definition to come...
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About NPI 1184404261
Colleen Ann Ly, PA-C's National Provider Identifier is 1184404261, issued on Oct 5, 2023. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in San Diego, CA. The record was last updated on Apr 24, 2026.