Healthcare Provider Details

I. General information

NPI: 1164621892
Provider Name (Legal Business Name): D LALANI PERERA-THANGARATNAM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W LA PALMA AVE
ANAHEIM CA
92801-2804
US

IV. Provider business mailing address

5 HOLLAND STE 101
IRVINE CA
92618-2568
US

V. Phone/Fax

Practice location:
  • Phone: 714-774-1450
  • Fax: 714-999-6165
Mailing address:
  • Phone: 949-588-2190
  • Fax: 949-588-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA70242
License Number StateCA

VIII. Authorized Official

Name: D LALANI PERERA-THANGARATNAM
Title or Position: PRESIDENT
Credential: MD
Phone: 949-588-2190