Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Colleen Ann Ly, PA-C

Individual provider Physician Assistant · NPI 1184404261

Colleen Ann Ly, PA-C is a Physician Assistant in San Diego, California. Qualified in 2023, 3 years ago. Practices with On Call Specialists Medical Group of San Diego Inc, a 144-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
3
Licensed in
CA
In the registry since
2023
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

4060 Fourth Ave Ste 700
San Diego, CA 92103-2121
Phone: (619) 299-8500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA63447 (CA)
Physician Assistant Taxonomy 363A00000X · Licence PA63447 (CA)

Record details

NPI number1184404261
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedOctober 5, 2023
Last updated in NPPESApril 24, 2026
Certification dateApril 24, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice On Call Specialists Medical Group Of San Diego Inc — 144 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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