1255644100 NPI number — TANYA NANAYAKKARA HALPER M.D.

Table of content: TANYA NANAYAKKARA HALPER M.D. (NPI 1255644100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255644100 NPI number — TANYA NANAYAKKARA HALPER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALPER
Provider First Name:
TANYA
Provider Middle Name:
NANAYAKKARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NANAYAKKARA
Provider Other First Name:
TANYA
Provider Other Middle Name:
SHANIKA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255644100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 TOWN AND COUNTRY DR STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92860-3611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 S MAIN ST STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92882-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-737-1454
Provider Business Practice Location Address Fax Number:
951-737-1822
Provider Enumeration Date:
07/21/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C165533 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)