Provider Demographics
NPI:1033248083
Name:GOONETILLEKE, RANJIT N (MD)
Entity Type:Individual
Prefix:
First Name:RANJIT
Middle Name:N
Last Name:GOONETILLEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RANJIT
Other - Middle Name:NIHAL
Other - Last Name:GOONETILLEKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:999 N TUSTIN AVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3528
Mailing Address - Country:US
Mailing Address - Phone:714-973-8522
Mailing Address - Fax:
Practice Address - Street 1:999 N TUSTIN AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3528
Practice Address - Country:US
Practice Address - Phone:714-973-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32430207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC35399Medicare UPIN
CAWA32430BMedicare PIN