Healthcare Provider Details

I. General information

NPI: 1386224707
Provider Name (Legal Business Name): RYAN LUCAS CHARTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON 200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

132 NIXON CIR
OCEANSIDE CA
92057-4424
US

V. Phone/Fax

Practice location:
  • Phone: 760-763-3241
  • Fax:
Mailing address:
  • Phone: 951-318-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number62702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: