Provider Demographics
NPI:1023018389
Name:CAMPANO, RUWANTHI SAMARANAYAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUWANTHI
Middle Name:SAMARANAYAKE
Last Name:CAMPANO
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 1:41301 12TH ST W STE A
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1465
Mailing Address - Country:US
Mailing Address - Phone:661-726-6277
Mailing Address - Fax:661-726-6291
Practice Address - Street 1:41301 12TH ST W STE A
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1465
Practice Address - Country:US
Practice Address - Phone:661-726-6277
Practice Address - Fax:661-726-6291
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69121207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691210Medicaid
CA00A691210Medicaid
CA00A691212Medicare ID - Type Unspecified