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General NPI Number Information
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NPI Number | 1043396559
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Entity Type | Individual
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Provider Name | VISHAL BANTHIA MD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 2390 FARADAY AVE
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City | CARLSBAD
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State | CA
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Zip | 92008-7216
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Country | US
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Telephone | 858-909-0770
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Fax | 858-909-0880
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Provider Business Mailing Address
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Address Line | 39899 BALENTINE DR STE 200
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City | NEWARK
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State | CA
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Zip | 94560-5361
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Country | US
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Telephone | 800-453-1420
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Fax | 800-453-1420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | S8419
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 4301501683
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | A86814
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | A86814
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License Number State | CA
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