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General NPI Number Information
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NPI Number | 1326278490
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Entity Type | Organization
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Legal Business Name | JANESRI DE SILVA M.D. A PROF CORP
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 504 S SIERRA MADRE BLVD
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City | PASADENA
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State | CA
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Zip | 91107-5240
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Country | US
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Telephone | 818-361-5437
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Fax | 626-406-1800
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Provider Business Mailing Address
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Address Line | 504 S SIERRA MADRE BLVD
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City | PASADENA
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State | CA
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Zip | 91107-5240
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Country | US
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Telephone | 818-361-5437
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Fax | 626-406-1800
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANESRI WIJAYANGANI DE SILVA
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Credential | M.D
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Telephone | 818-361-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | A88991
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A88991
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License Number State | CA
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