Provider Demographics
NPI:1679753347
Name:NANDI WIJESINGHE, M.D., INC
Entity Type:Organization
Organization Name:NANDI WIJESINGHE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAPITIYAGE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WIJESINGHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-774-8870
Mailing Address - Street 1:947 S ANAHEIM BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5582
Mailing Address - Country:US
Mailing Address - Phone:714-774-8870
Mailing Address - Fax:714-635-5704
Practice Address - Street 1:947 S ANAHEIM BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5582
Practice Address - Country:US
Practice Address - Phone:714-774-8870
Practice Address - Fax:714-635-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33740207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337401Medicaid
CA00A337400Medicaid
CA00A337402Medicaid
CA00A337400Medicaid