Healthcare Provider Details

I. General information

NPI: 1134655111
Provider Name (Legal Business Name): THARANGA WEERASINGHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10418 VALLEY BLVD STE A
EL MONTE CA
91731-3600
US

IV. Provider business mailing address

10418 VALLEY BLVD STE B
EL MONTE CA
91731-3600
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone: 323-562-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA165105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: