Provider Demographics
NPI:1114939659
Name:DR LOKESH S TANTUWAYA M D INC
Entity Type:Organization
Organization Name:DR LOKESH S TANTUWAYA M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANTUWAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-300-2626
Mailing Address - Street 1:PO BOX 236105
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-6105
Mailing Address - Country:US
Mailing Address - Phone:858-300-2626
Mailing Address - Fax:858-300-2627
Practice Address - Street 1:7830 CLAIREMONT MESA BLVD # 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1619
Practice Address - Country:US
Practice Address - Phone:858-300-2626
Practice Address - Fax:858-300-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5757670001Medicare NSC
CAW20434Medicare PIN