Provider Demographics
NPI:1497836464
Name:NANAYAKKARA, NALIN (MD)
Entity Type:Individual
Prefix:
First Name:NALIN
Middle Name:
Last Name:NANAYAKKARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 S WASHBURN
Mailing Address - Street 2:STE 9
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:951-371-1590
Mailing Address - Fax:951-735-6553
Practice Address - Street 1:760 S WASHBURN
Practice Address - Street 2:STE 9
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882
Practice Address - Country:US
Practice Address - Phone:951-371-1590
Practice Address - Fax:951-735-6553
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35609207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A356092Medicaid
C03943Medicare UPIN
CA00A356092Medicaid