Healthcare Provider Details

I. General information

NPI: 1598931677
Provider Name (Legal Business Name): GEORGE M. JAYATILAKA, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE SUITE 116
LONG BEACH CA
90804-2105
US

IV. Provider business mailing address

1760 TERMINO AVE SUITE 116
LONG BEACH CA
90804-2105
US

V. Phone/Fax

Practice location:
  • Phone: 562-597-8885
  • Fax: 562-597-3108
Mailing address:
  • Phone: 562-597-8885
  • Fax: 562-597-3108

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