Provider Demographics
NPI:1639209109
Name:WIJEGUNAWARDENE, VIJITHA KUMARI (BA)
Entity Type:Individual
Prefix:MRS
First Name:VIJITHA
Middle Name:KUMARI
Last Name:WIJEGUNAWARDENE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:VIJITHA
Other - Middle Name:KUMARIHAMY
Other - Last Name:TALAGUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:433 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-1822
Mailing Address - Country:US
Mailing Address - Phone:562-435-1309
Mailing Address - Fax:
Practice Address - Street 1:18432 GRIDLEY RD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5404
Practice Address - Country:US
Practice Address - Phone:562-860-2479
Practice Address - Fax:562-860-7109
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner