Basic Information
| Provider Information | |||||||||
| NPI: | 1881685188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VISKANTA | ||||||||
| FirstName: | TOMAS | ||||||||
| MiddleName: | LINAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 SAN DIEGUITO DR | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920244536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602302829 | ||||||||
| FaxNumber: | 2095244240 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 SAN DIEGUITO DR | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920244536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602302829 | ||||||||
| FaxNumber: | 2095244240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 04/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SE0003X | PA16272 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Emergency | 363AM0700X | PA16272 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.