Healthcare Provider Details

I. General information

NPI: 1922001346
Provider Name (Legal Business Name): MAPITIYAGE N WIJESINGHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/01/2014
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/23/2006

III. Provider practice location address

174 W LINCOLN AVE SUITE 582
ANAHEIM CA
92805-2901
US

IV. Provider business mailing address

174 W LINCOLN AVE SUITE 582
ANAHEIM CA
92805-2901
US

V. Phone/Fax

Practice location:
  • Phone: 714-470-3260
  • Fax:
Mailing address:
  • Phone: 714-470-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA33740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: