Healthcare Provider Details

I. General information

NPI: 1326788142
Provider Name (Legal Business Name): HARENDRA IPALAWATTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W JANSS RD
THOUSAND OAKS CA
91360-1847
US

IV. Provider business mailing address

23361 LEONORA DR
WOODLAND HILLS CA
91367-6040
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-2727
  • Fax:
Mailing address:
  • Phone: 818-439-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA191860
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27657
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: