Provider Demographics
NPI:1407944002
Name:DESILVA, NEELANTHA MENAKA (MD)
Entity Type:Individual
Prefix:
First Name:NEELANTHA
Middle Name:MENAKA
Last Name:DESILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MENAKA
Other - Middle Name:NEELANTHA
Other - Last Name:DESILVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1140 W LA VETA AVE STE 730
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4229
Mailing Address - Country:US
Mailing Address - Phone:714-541-6800
Mailing Address - Fax:714-541-1119
Practice Address - Street 1:1140 W LA VETA AVE STE 730
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4229
Practice Address - Country:US
Practice Address - Phone:714-541-6800
Practice Address - Fax:714-541-1119
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68917174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH82705Medicare UPIN
CAWA68917AMedicare PIN