Healthcare Provider Details

I. General information

NPI: 1326347113
Provider Name (Legal Business Name): TUSHANI DIMANTHA ILLANGASEKARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 6D SFGH OB GYN
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

251 PARNASSUS AVE APT 1
SAN FRANCISCO CA
94117-3801
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-4069
  • Fax:
Mailing address:
  • Phone: 530-848-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA123931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: