Provider Demographics
NPI:1083712236
Name:DE SILVA, ERRAJITH BERTRAND RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERRAJITH BERTRAND
Middle Name:RICARDO
Last Name:DE SILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BERTRAND
Other - Middle Name:RICARDO
Other - Last Name:DE SILVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4121 BROCKTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3442
Mailing Address - Country:US
Mailing Address - Phone:951-778-0032
Mailing Address - Fax:714-333-4508
Practice Address - Street 1:4121 BROCKTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3442
Practice Address - Country:US
Practice Address - Phone:951-778-0032
Practice Address - Fax:714-333-4508
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46400207R00000X, 207RP1001X, 207RS0012X, 208M00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
409-444-7OtherECFMG
CA00A464000Medicaid
CA290008214OtherMEDICARE RR
CA290008214OtherMEDICARE RR
CAWA46400HMedicare PIN
CAWA46400CMedicare PIN
CAF14824Medicare UPIN
CAWA46400FMedicare PIN
CAAU279Medicare PIN
CA290008214OtherMEDICARE RR
CA00A464000Medicaid