Healthcare Provider Details

I. General information

NPI: 1043496094
Provider Name (Legal Business Name): HIMANSHU V WICKRAMASINGHE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2008
Last Update Date: 01/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23928 LYONS AVE
NEWHALL CA
91321-2409
US

IV. Provider business mailing address

2290 SHERWOOD RD
SAN MARINO CA
91108-2836
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-7216
  • Fax: 661-254-4830
Mailing address:
  • Phone: 626-292-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA56078
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA56078
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA56078
License Number StateCA

VIII. Authorized Official

Name: DR. HIMANSHU V WICKRAMASINGHE
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 626-292-2401