Provider Demographics
NPI:1609468362
Name:DODANGODA ARACHCHIGE, PRAMODA MADUBHASHANI (HIS)
Entity Type:Individual
Prefix:
First Name:PRAMODA
Middle Name:MADUBHASHANI
Last Name:DODANGODA ARACHCHIGE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GOLD RUSH CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1463
Mailing Address - Country:US
Mailing Address - Phone:925-759-8122
Mailing Address - Fax:
Practice Address - Street 1:1313 TRAVIS BLVD STE C
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4621
Practice Address - Country:US
Practice Address - Phone:707-428-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHT10101237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist