Basic Information
| Provider Information | |||||||||
| NPI: | 1114939659 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR LOKESH S TANTUWAYA M D INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 236105 | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920236105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583002626 | ||||||||
| FaxNumber: | 8583002627 | ||||||||
| Practice Location | |||||||||
| Address1: | 7830 CLAIREMONT MESA BLVD # 203 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921111619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583002626 | ||||||||
| FaxNumber: | 8583002627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 10/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | TANTUWAYA | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8583002626 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G79268 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.