Healthcare Provider Details

I. General information

NPI: 1447503974
Provider Name (Legal Business Name): SERENDIB HEALTHWAYS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14608 VICTORY BLVD
VAN NUYS CA
91411-1621
US

IV. Provider business mailing address

18543 DEVONSHIRE ST SUITE 435
NORTHRIDGE CA
91324-1308
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-7710
  • Fax: 818-786-7711
Mailing address:
  • Phone: 818-786-7710
  • Fax: 818-786-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA88991
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JANESRI W DE SILVA
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: M.D
Phone: 818-786-7710