Healthcare Provider Details

I. General information

NPI: 1437325404
Provider Name (Legal Business Name): GEORGE M. JAYATILAKA, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE SUITE 818
LONG BEACH CA
90813-3408
US

IV. Provider business mailing address

1045 ATLANTIC AVE SUITE 818
LONG BEACH CA
90813-3408
US

V. Phone/Fax

Practice location:
  • Phone: 562-436-8117
  • Fax: 562-432-2777
Mailing address:
  • Phone: 562-436-8117
  • Fax: 562-432-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MARIA SAMALA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 562-436-8117