Provider Demographics
NPI:1881685188
Name:VISKANTA, TOMAS LINAS (PA)
Entity Type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:LINAS
Last Name:VISKANTA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SAN DIEGUITO DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4536
Mailing Address - Country:US
Mailing Address - Phone:760-230-2829
Mailing Address - Fax:209-524-4240
Practice Address - Street 1:650 SAN DIEGUITO DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4536
Practice Address - Country:US
Practice Address - Phone:760-230-2829
Practice Address - Fax:209-524-4240
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16272364SE0003X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB252780Medicare PIN