Provider Demographics
NPI:1326455916
Name:GUNAWARDHANA, AYOMA JAYAMINI (FNP,NP-C)
Entity Type:Individual
Prefix:
First Name:AYOMA
Middle Name:JAYAMINI
Last Name:GUNAWARDHANA
Suffix:
Gender:F
Credentials:FNP,NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 CLAREMONT ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6616
Mailing Address - Country:US
Mailing Address - Phone:909-437-8347
Mailing Address - Fax:
Practice Address - Street 1:3811 CLAREMONT ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6616
Practice Address - Country:US
Practice Address - Phone:909-437-8347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily