Provider Demographics
NPI:1649571779
Name:WIJESINGHE PEDIATRICS
Entity Type:Organization
Organization Name:WIJESINGHE PEDIATRICS
Other - Org Name:SIENA PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIJESINGHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-248-7337
Mailing Address - Street 1:2847 SAINT ROSE PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4845
Mailing Address - Country:US
Mailing Address - Phone:702-248-7337
Mailing Address - Fax:702-478-5465
Practice Address - Street 1:2441 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5788
Practice Address - Country:US
Practice Address - Phone:702-248-7337
Practice Address - Fax:702-478-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001222261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care