Healthcare Provider Details

I. General information

NPI: 1952251381
Provider Name (Legal Business Name): ALYSSA ANNE BANTAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 CALLE MAGDALENA STE 101
ENCINITAS CA
92024-3793
US

IV. Provider business mailing address

621 EDGEWATER DR
SAN MARCOS CA
92078-6001
US

V. Phone/Fax

Practice location:
  • Phone: 866-278-8495
  • Fax:
Mailing address:
  • Phone: 760-975-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: