MEDICARE: MR. TOMAS LINAS VISKANTA PA

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	364SE0003X	Emergency Clinical Nurse Specialist	PA16272	CA
2	363AM0700X	Medical Physician Assistant	PA16272	CA

General Provider Information

NPI Number	:	1881685188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOMAS LINAS VISKANTA PA

Provider Business Mailing Address
First Line	:	650 SAN DIEGUITO DR
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-4536
Country	:	US
Telephone Number	:	760-230-2829
Fax Number	:	209-524-4240

Provider Business Practice Location Address
First Line	:	650 SAN DIEGUITO DR
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-4536
Country	:	US
Telephone Number	:	760-230-2829
Fax Number	:	209-524-4240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	04/28/2016

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