Basic Information
| Provider Information | |||||||||
| NPI: | 1821012170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANTUWAYA | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2114 | ||||||||
| Address2: | |||||||||
| City: | RANCHO SANTA FE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920672114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587598945 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7830 CLAIREMONT MESA BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921111619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583002626 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 10702 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.