Provider Demographics
NPI:1063043693
Name:KEERTHISINGHE, HIRANSHA S
Entity Type:Individual
Prefix:MRS
First Name:HIRANSHA
Middle Name:S
Last Name:KEERTHISINGHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18603 JEFFREY AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6154
Mailing Address - Country:US
Mailing Address - Phone:562-286-3516
Mailing Address - Fax:586-286-8875
Practice Address - Street 1:18603 JEFFREY AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6154
Practice Address - Country:US
Practice Address - Phone:562-286-3516
Practice Address - Fax:586-286-8875
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198602361310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility