Healthcare Provider Details

I. General information

NPI: 1568502953
Provider Name (Legal Business Name): JANESRI W DE SILVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 SEPULVEDA BLVD SUITE 101
MISSION HILLS CA
91345-1934
US

IV. Provider business mailing address

18543 DEVONSHIRE ST SUITE 430
NORTHRIDGE CA
91324-1308
US

V. Phone/Fax

Practice location:
  • Phone: 818-361-5437
  • Fax: 818-361-5695
Mailing address:
  • Phone: 818-361-5437
  • Fax: 818-361-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA88991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: