Individual
COLLEEN ANN LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4060 FOURTH AVE STE 700, SAN DIEGO, CA 92103-2121
(619) 299-8500
Mailing address
4060 FOURTH AVE STE 700, SAN DIEGO, CA 92103-2121
(619) 299-8500
(619) 299-1948
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA63447
CA
363AS0400X
Surgical Physician Assistant
Primary
PA63447
CA
Other
Enumeration date
10/05/2023
Last updated
04/24/2026
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