Tracey Lee Lysander, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

32580 Issued in CA

Practice address

15835 Pomerado Rd Ste 403
Poway, CA 92064-2043

Phone

(858) 451-8321

Fax

(858) 451-8302

NPI assigned

Nov 14, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306918487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15835 POMERADO RD STE 403",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642043",
            "telephone_number": "858-451-8321",
            "fax_number": "858-451-8302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15835 POMERADO RD STE 403",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642043",
            "telephone_number": "858-451-8321",
            "fax_number": "858-451-8302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSANDER",
        "first_name": "TRACEY",
        "middle_name": "LEE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "32580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jessica Bradley Mackay, RNFA

• Dentist in Poway, CA
• Providers in Poway, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.