Healthcare Provider Details

I. General information

NPI: 1528209723
Provider Name (Legal Business Name): WALTER JAYASINGHE MD, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 WILSHIRE BLVD 2ND FLOOR
LOS ANGELES CA
90057-3507
US

IV. Provider business mailing address

2010 WILSHIRE BLVD 2ND FLOOR
LOS ANGELES CA
90057-3507
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-9209
  • Fax: 213-483-0250
Mailing address:
  • Phone: 213-483-9209
  • Fax: 213-483-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53229
License Number StateCA

VIII. Authorized Official

Name: MS. PATRICIA HALE
Title or Position: ADMINISITRATOR
Credential:
Phone: 213-483-2620