Healthcare Provider Details

I. General information

NPI: 1295234276
Provider Name (Legal Business Name): TIMOTHY JAMES PEIRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 BLOOMFIELD AVE FL 1
SANTA FE SPRINGS CA
90670-4750
US

IV. Provider business mailing address

12400 BLOOMFIELD AVE FL 1
SANTA FE SPRINGS CA
90670-4750
US

V. Phone/Fax

Practice location:
  • Phone: 562-967-2820
  • Fax:
Mailing address:
  • Phone: 562-967-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA173295
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA173295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: