Individual provider Active NPI

Daniel J Lyons, PHARM.D

  • Pharmacist
  • San Ysidro, CA
National Provider Identifier
1205155389
Registry record updated Sep 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
55205 Issued in CA
Practice address
4575 Camino de la PLZ Ste 106
San Ysidro, CA 92173-3157
Phone
(619) 407-5555
Fax
(619) 407-6718
NPI assigned
May 27, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 55205 CA Primary

Addresses

Primary practice location

4575 Camino de la PLZ Ste 106
San Ysidro, CA 92173-3157

Mailing address

4575 Camino de la PLZ Ste 106
San Ysidro, CA 92173-3157
Phone (619) 407-5555

Other identifiers 1

IdentifierTypeStateIssuer
1902442387MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

Practice roles

OrganizationSpecialtyStatusNew patients
Leo Salutem Inc CurrentSince Dec 1, 2023 Accepting new patients
Leo Salutem Inc CurrentSince Nov 1, 2021 Accepting new patients

Locations

660 Palomar St
Unit 410411
Chula Vista, CA 91911

642 Palomar St
Ste 410
Chula Vista, CA 91911
Phone (619) 407-5555

4575 Camino de la Plz
Ste 106
San Ysidro, CA 92173
Phone (619) 407-5555

Organizations & group practices 2

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": "1274918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757980800000",
    "number": "1205155389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4575 CAMINO DE LA PLZ STE 106",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921733157",
            "telephone_number": "619-407-5555",
            "fax_number": "619-407-6718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4575 CAMINO DE LA PLZ STE 106",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921733157",
            "telephone_number": "619-407-5555",
            "fax_number": "619-407-6718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYONS",
        "first_name": "DANIEL",
        "middle_name": "J",
        "credential": "PHARM.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-27",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "55205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902442387",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Ysidro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.