Provider Demographics
NPI:1659312957
Name:ABAYARATNA, DILOJAN PRASANNA (DC)
Entity Type:Individual
Prefix:DR
First Name:DILOJAN
Middle Name:PRASANNA
Last Name:ABAYARATNA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 LA TIJERA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3906
Mailing Address - Country:US
Mailing Address - Phone:310-645-1485
Mailing Address - Fax:310-645-5608
Practice Address - Street 1:8713 LA TIJERA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3906
Practice Address - Country:US
Practice Address - Phone:310-645-1485
Practice Address - Fax:310-645-5608
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27376Medicare ID - Type Unspecified
CAU85205Medicare UPIN