Provider Demographics
NPI:1316550981
Name:EKANAYAKE, CHAMINDA HILARY
Entity Type:Individual
Prefix:
First Name:CHAMINDA
Middle Name:HILARY
Last Name:EKANAYAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10463 HORN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2590
Mailing Address - Country:US
Mailing Address - Phone:818-371-7978
Mailing Address - Fax:
Practice Address - Street 1:10463 HORN BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2590
Practice Address - Country:US
Practice Address - Phone:818-371-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)