Provider Demographics
NPI:1518070382
Name:ARSECULARATNE, LATIKA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:LATIKA
Middle Name:D
Last Name:ARSECULARATNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 W LA VETA AVE STE 700
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:714-547-5404
Mailing Address - Fax:714-547-0935
Practice Address - Street 1:1140 W LA VETA AVE STE 700
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:714-547-5404
Practice Address - Fax:714-547-0935
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01470052 - DU5182OtherRR MEDICARE
CAEFFECTIVE 10/12/2015OtherCALIFORNIA CHILDREN'S SERVICES (CCS)
CAP01470062 - DU4034OtherRR MEDICARE
CAEFF: 5/27/2009Medicaid
CAP01470062 - DU4034OtherRR MEDICARE
CAP01470052 - DU5182OtherRR MEDICARE