Provider Demographics
NPI:1497068100
Name:PERERA, ISIRA JAYANATH ARAVINDA (MBBS,MD)
Entity Type:Individual
Prefix:DR
First Name:ISIRA
Middle Name:JAYANATH ARAVINDA
Last Name:PERERA
Suffix:
Gender:M
Credentials:MBBS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 E SHEPHERD AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5616
Mailing Address - Country:US
Mailing Address - Phone:559-472-3377
Mailing Address - Fax:
Practice Address - Street 1:1830 E SHEPHERD AVE APT 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-5616
Practice Address - Country:US
Practice Address - Phone:559-472-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine