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General NPI Number Information
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NPI Number | 1902166721
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Entity Type | Organization
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Legal Business Name | SERENDIB HEALTHWAYS, INC
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Dates
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Enumeration Date | 05/26/2012
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Last Update Date | 05/26/2012
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Provider Practice Location Address
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Address Line | 14608 VICTORY BLVD
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City | VAN NUYS
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State | CA
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Zip | 91411-1621
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Country | US
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Telephone | 818-786-7710
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Fax | 818-786-7711
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Provider Business Mailing Address
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Address Line | 18543 DEVONSHIRE ST SUITE 435
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City | NORTHRIDGE
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State | CA
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Zip | 91324-1308
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Country | US
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Telephone | 818-786-7710
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Fax | 818-786-7711
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANESRI W DE SILVA
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Credential | M.D.
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Telephone | 818-305-3755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | A889910
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A889910
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License Number State | CA
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