Healthcare Provider Details

I. General information

NPI: 1568303949
Provider Name (Legal Business Name): WATHMA NETHMINI RUPASINGHE DISSANAYAKE MUDIYANSELAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WATHMA DISSANAYAKE

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 E CLINTON WAY
FRESNO CA
93727-2014
US

IV. Provider business mailing address

4166 N WARREN AVE
FRESNO CA
93705-1957
US

V. Phone/Fax

Practice location:
  • Phone: 559-253-2277
  • Fax:
Mailing address:
  • Phone: 805-664-0864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: