Provider Demographics
NPI:1225551856
Name:DELTA ROMEO TANGO LLC
Entity Type:Organization
Organization Name:DELTA ROMEO TANGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOKESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:TANTAUWAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:858-408-9400
Practice Address - Street 1:2751 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4753
Practice Address - Country:US
Practice Address - Phone:858-300-2626
Practice Address - Fax:858-408-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10014A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty