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General NPI Number Information
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NPI Number | 1114939659
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Entity Type | Organization
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Legal Business Name | DR LOKESH S TANTUWAYA M D INC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 7830 CLAIREMONT MESA BLVD # 203
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City | SAN DIEGO
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State | CA
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Zip | 92111-1619
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Country | US
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Telephone | 858-300-2626
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Fax | 858-300-2627
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Provider Business Mailing Address
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Address Line | PO BOX 236105
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City | ENCINITAS
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State | CA
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Zip | 92023-6105
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Country | US
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Telephone | 858-300-2626
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Fax | 858-300-2627
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KRISTEN TANTUWAYA
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Credential |
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Telephone | 858-300-2626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G79268
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License Number State | CA
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