Healthcare Provider Details

I. General information

NPI: 1285927582
Provider Name (Legal Business Name): AMAYA LY MSN, RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 OCEAN RANCH BLVD
OCEANSIDE CA
92056-2703
US

IV. Provider business mailing address

367 N MAGNOLIA AVE STE 101
EL CAJON CA
92020-3995
US

V. Phone/Fax

Practice location:
  • Phone: 760-967-4401
  • Fax:
Mailing address:
  • Phone: 619-441-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number80054
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number792960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: