Provider Demographics
NPI:1073612529
Name:VASILIAUSKAS, TOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:
Last Name:VASILIAUSKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DOYLE PARK DR
Mailing Address - Street 2:SUITE G05
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4558
Mailing Address - Country:US
Mailing Address - Phone:707-576-7100
Mailing Address - Fax:707-576-8482
Practice Address - Street 1:500 DOYLE PARK DR
Practice Address - Street 2:SUITE G05
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-576-7100
Practice Address - Fax:707-576-8482
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51710207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC51710OtherCALIFORNIA STATE LICENSE
CAC51710OtherCALIFORNIA STATE LICENSE