Provider Demographics
NPI:1871859421
Name:BOYD, LISA NAKHLEH (PA)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:NAKHLEH
Last Name:BOYD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:NAKHLEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9000
Mailing Address - Country:US
Mailing Address - Phone:800-926-8273
Mailing Address - Fax:888-539-8781
Practice Address - Street 1:2999 HEALTH CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-939-4480
Practice Address - Fax:858-939-4452
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20326363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical