1457360489 NPI number — A.JAYALATH C. DE SILVA M.D. A MEDICAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457360489 NPI number — A.JAYALATH C. DE SILVA M.D. A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A.JAYALATH C. DE SILVA M.D. A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457360489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91116-6790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-204-6747
Provider Business Mailing Address Fax Number:
626-396-0851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 N FIFTH AVE
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91106-3739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-471-9901
Provider Business Practice Location Address Fax Number:
626-471-9020
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DE SILVA
Authorized Official First Name:
ARUMAKANKANI
Authorized Official Middle Name:
JAYALATH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-932-0530

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , 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)

  • Identifier: 00A318310 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A318310 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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