Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301501683 | MI |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A86814 | CA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A86814 | CA |
NPI | 1043396559 |
---|---|
Provider Name | Vishal Banthia |
First Address | Carlsbad, CA 92008-7216 |
Second Address | Carlsbad, CA 92008-7216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A868140 | (05) | CA |
I12712 | (02) |