Healthcare Provider Details

I. General information

NPI: 1730100330
Provider Name (Legal Business Name): UDAYA DESILVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 W AVENUE Q SUITE A
PALMDALE CA
93551-3890
US

IV. Provider business mailing address

PO BOX 4037
LANCASTER CA
93539-4037
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-6255
  • Fax: 661-726-6261
Mailing address:
  • Phone: 661-726-6255
  • Fax: 661-726-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA48836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: