Provider Demographics
NPI:1790522753
Name:LYKISSAS, LISA (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LYKISSAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 S MOLLISON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-7735
Mailing Address - Country:US
Mailing Address - Phone:619-861-0410
Mailing Address - Fax:
Practice Address - Street 1:1125 S MOLLISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-7735
Practice Address - Country:US
Practice Address - Phone:619-861-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2024055555363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care