Individual provider Active NPI

Sydney Karina Myers

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1114780475
Registry record updated Dec 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
65200 Issued in CA
Practice address
4060 Fairmount Ave
San Diego, CA 92105-1608
Phone
(619) 255-9155
NPI assigned
Jan 31, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 65200 CA Primary

Addresses

Primary practice location

4060 Fairmount Ave
San Diego, CA 92105-1608

Mailing address

7128 N Corrida de Venado
Tucson, AZ 85718-1149

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251226001323 CA Practitioner - Physician Assistant 6608372057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

21410 NE 14TH Street
Sammamish, WA 98074

4060 Fairmount Ave
San Diego, CA 92105-1608

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
65200CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
La Maestra Family Clinic, Inc. CurrentSince Oct 13, 2025 Accepting new patients
La Maestra Family Clinic, Inc. CurrentSince Oct 13, 2025 Accepting new patients

Locations

165 S 1st St
El Cajon, CA 92019
Phone (619) 312-0347

4074 Fairmount Ave
San Diego, CA 92105
Phone (619) 284-1141

4060 Fairmount Ave
San Diego, CA 92105
Phone (619) 255-9155

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766880000000",
    "number": "1114780475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7128 N CORRIDA DE VENADO",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857181149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-255-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "SYDNEY",
        "middle_name": "KARINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-31",
        "last_updated": "2025-12-28",
        "certification_date": "2025-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "65200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.