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General NPI Number Information
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NPI Number | 1992979702
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Entity Type | Organization
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Legal Business Name | R. NIHAL GOONETILLEKE INC.
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 999 N. TUSTIN AVE. 224
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City | SANTA ANA
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State | CA
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Zip | 92705-6506
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Country | US
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Telephone | 714-973-8522
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Fax |
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Provider Business Mailing Address
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Address Line | 999 N. TUSTIN AVE. 224
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City | SANTA ANA
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State | CA
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Zip | 92705-6506
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Country | US
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Telephone | 714-973-8522
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | RANJIT NIHAL GOONETILLEKE
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Credential | M.D.
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Telephone | 714-973-8522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A32430
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License Number State | CA
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