1750645024 NPI number — DR. GERARD IRU IRANTHA FERNANDO M.D.

Table of content: DR. GERARD IRU IRANTHA FERNANDO M.D. (NPI 1750645024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750645024 NPI number — DR. GERARD IRU IRANTHA FERNANDO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDO
Provider First Name:
GERARD
Provider Middle Name:
IRU IRANTHA
Provider Name Prefix Text:
DR.
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:
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:
1750645024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10748
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93389-0748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-431-1555
Provider Business Mailing Address Fax Number:
661-471-2410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8329 BRIMHALL ROAD
Provider Second Line Business Practice Location Address:
SUITE 804
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-431-1555
Provider Business Practice Location Address Fax Number:
661-471-2410
Provider Enumeration Date:
07/01/2012

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: 2084P0800X , with the licence number:  A145394 , 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)





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