Provider Demographics
NPI:1710289749
Name:PERERA, PRIYANTHA (LSA)
Entity Type:Individual
Prefix:MR
First Name:PRIYANTHA
Middle Name:
Last Name:PERERA
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:RANASINGHE
Other - Middle Name:PRIYANTHA
Other - Last Name:PERERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7324 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 1550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2053
Mailing Address - Country:US
Mailing Address - Phone:713-779-9800
Mailing Address - Fax:713-779-9813
Practice Address - Street 1:7324 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 1550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2053
Practice Address - Country:US
Practice Address - Phone:713-779-9800
Practice Address - Fax:713-779-9813
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10-136246ZS0410X
TXSA00386246ZS0410X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist