MEDICARE: DR LOKESH S TANTUWAYA M D INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G79268	CA

General Provider Information

NPI Number	:	1114939659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR LOKESH S TANTUWAYA M D INC

Provider Business Mailing Address
First Line	:	PO BOX 236105
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92023-6105
Country	:	US
Telephone Number	:	858-300-2626
Fax Number	:	858-300-2627

Provider Business Practice Location Address
First Line	:	7830 CLAIREMONT MESA BLVD # 203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1619
Country	:	US
Telephone Number	:	858-300-2626
Fax Number	:	858-300-2627

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KRISTEN TANTUWAYA
Credential	:
Telephone Number	:	858-300-2626

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	10/29/2015

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