LYSA SAMUEL PA NPI 1174737423

NPI Information

  • NPI: 1174737423
  • Provider Name: LYSA SAMUEL, PA
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3100 TELEGRAPH AVE
    #2109 EAST BAY FAMILY PRACTICE MEDICAL GROUP INC
    OAKLAND, CA
    ZIP 94609
  • Phone: (510) 645-9900

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NPI Details

Lysa Samuel, PA is a medical physician assistant in Oakland, CA with 25 years of experience. Lysa Samuel, PA NPI is 1174737423. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3100 TELEGRAPH AVE
#2109 EAST BAY FAMILY PRACTICE MEDICAL GROUP INC
OAKLAND, CA
ZIP 94609
Phone: (510) 645-9900
Fax: (510) 645-9919

The NPI 1174737423 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/9/2007 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedicalPA16296Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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