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1306774625 NPI number — PAVITHRA SAMANMALEE KODAGODA MBBS

NPI Number: 1306774625
Health Care Provider/Practitioner: PAVITHRA SAMANMALEE KODAGODA MBBS

Information about “1306774625” NPI (PAVITHRA SAMANMALEE KODAGODA MBBS) exists in 1306774625 in HTML format HTML  |  1306774625 in plain Text format TXT  |  1306774625 in PDF (Portable Document Format) PDF  |  1306774625 in an XML format XML  formats.

NPI Number : 1306774625 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306774625",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KODAGODA",
    "FirstName": "PAVITHRA",
    "MiddleName": "SAMANMALEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MBBS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9950 JILL ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANTEE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92071-1563",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "619-983-5110",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "751 LIBERTY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEADVILLE",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "16335-2591",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "814-807-1660",
    "PracticeLocationAddressFaxNumber": "814-373-5259",
    "EnumerationDate": "05/08/2026",
    "LastUpdateDate": "05/08/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "390200000X",
        "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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