Provider Demographics
NPI:1598931677
Name:GEORGE M. JAYATILAKA, MD INC
Entity Type:Organization
Organization Name:GEORGE M. JAYATILAKA, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-436-8117
Mailing Address - Street 1:1760 TERMINO AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2105
Mailing Address - Country:US
Mailing Address - Phone:562-597-8885
Mailing Address - Fax:562-597-3108
Practice Address - Street 1:1760 TERMINO AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2105
Practice Address - Country:US
Practice Address - Phone:562-597-8885
Practice Address - Fax:562-597-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79153ZMedicaid