Provider Demographics
NPI:1003033374
Name:RANASINGHE, MOKSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOKSHA
Middle Name:
Last Name:RANASINGHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BEVERLY BLVD STE 404A
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4317
Mailing Address - Country:US
Mailing Address - Phone:213-369-4583
Mailing Address - Fax:866-876-7956
Practice Address - Street 1:101 E BEVERLY BLVD STE 404A
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:213-369-4583
Practice Address - Fax:866-876-7956
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA129389207T00000X
PAMD438027207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB235128OtherMEDICARE PTAN