Provider Demographics
NPI:1437268174
Name:SENEVIRATNE, LASIKA CHANDRADATTA (MD)
Entity Type:Individual
Prefix:DR
First Name:LASIKA
Middle Name:CHANDRADATTA
Last Name:SENEVIRATNE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:541 W COLORADO ST STE 205
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3640
Mailing Address - Country:US
Mailing Address - Phone:323-254-0046
Mailing Address - Fax:323-488-9782
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-977-1214
Practice Address - Fax:213-482-8868
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA56331207RH0003X, 207RH0003X
CA185517207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA056331OtherCA MEDICAL LICENSE
CA00A563310Medicaid
CAH 96963Medicare UPIN