Provider Demographics
NPI:1982991337
Name:CONSENSUS MD INC
Entity Type:Organization
Organization Name:CONSENSUS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VRIJESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:TANTUWAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-312-5016
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92074-1114
Mailing Address - Country:US
Mailing Address - Phone:858-312-5016
Mailing Address - Fax:858-312-5018
Practice Address - Street 1:12630 MONTE VISTA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2530
Practice Address - Country:US
Practice Address - Phone:858-312-5016
Practice Address - Fax:858-312-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79530207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty