Healthcare Provider Details

I. General information

NPI: 1316275613
Provider Name (Legal Business Name): LYNN MCCOMAS MSN, ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL SUITE 208A
ENCINITAS CA
92024-1328
US

IV. Provider business mailing address

10170 SORRENTO VALLEY RD
SAN DIEGO CA
92121-1604
US

V. Phone/Fax

Practice location:
  • Phone: 760-479-3900
  • Fax:
Mailing address:
  • Phone: 858-784-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number397581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: