Provider Demographics
NPI:1083855282
Name:WALTER JAYASINGHE MD APC
Entity Type:Organization
Organization Name:WALTER JAYASINGHE MD APC
Other - Org Name:LOS ANGELES MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISITRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PARTICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-483-2620
Mailing Address - Street 1:679 S WESTLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3505
Mailing Address - Country:US
Mailing Address - Phone:213-413-4141
Mailing Address - Fax:213-484-6280
Practice Address - Street 1:679 S WESTLAKE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3505
Practice Address - Country:US
Practice Address - Phone:213-413-4141
Practice Address - Fax:213-484-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53229208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336275981Medicaid