Provider Demographics
NPI:1528214525
Name:P DHANAPALA RODRIGO MD A MEDICAL CORP
Entity Type:Organization
Organization Name:P DHANAPALA RODRIGO MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:PULAHINGE
Authorized Official - Middle Name:DHANAPALA
Authorized Official - Last Name:RODRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-544-5653
Mailing Address - Street 1:PO BOX 1809
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92856-0809
Mailing Address - Country:US
Mailing Address - Phone:714-560-1580
Mailing Address - Fax:714-560-1585
Practice Address - Street 1:280 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3852
Practice Address - Country:US
Practice Address - Phone:714-704-1900
Practice Address - Fax:714-704-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37525207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A37525Medicaid
CAA37525Medicare PIN