Provider Demographics
NPI:1194029629
Name:KODITUWAKKU-COORAY, LAKMALI (PA-C)
Entity Type:Individual
Prefix:
First Name:LAKMALI
Middle Name:
Last Name:KODITUWAKKU-COORAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15717 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4377
Mailing Address - Country:US
Mailing Address - Phone:562-531-2231
Mailing Address - Fax:562-531-8845
Practice Address - Street 1:15717 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-4377
Practice Address - Country:US
Practice Address - Phone:562-531-2231
Practice Address - Fax:562-531-8845
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant