MEDICARE: MISS MYTHILLA KARUNARATNE FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	14073	CA

General Provider Information

NPI Number	:	1285765313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MYTHILLA KARUNARATNE FNP-BC

Provider Business Mailing Address
First Line	:	2161 YGNACIO VALLEY RD STE 100
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 YGNACIO VALLEY RD STE 100
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3348
Country	:	US
Telephone Number	:	925-378-5871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	02/11/2025

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