Provider Demographics
NPI:1508847187
Name:DANDILLAYA, RAMANAND C (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMANAND
Middle Name:C
Last Name:DANDILLAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAM
Other - Middle Name:C
Other - Last Name:DANDILLAYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:210 S PALISADE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8901
Mailing Address - Country:US
Mailing Address - Phone:805-928-5851
Mailing Address - Fax:805-922-1963
Practice Address - Street 1:210 S PALISADE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8901
Practice Address - Country:US
Practice Address - Phone:805-928-5851
Practice Address - Fax:805-922-1963
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35267207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
183223000OtherUSDL PIN
CA00A352670OtherBLUE SHIELD OF CALIFORNIA
CA00A352670Medicaid
183223000OtherUSDL PIN
WA35267JMedicare PIN
CA756131359Medicare PIN