Provider Demographics
NPI:1720384548
Name:EMPIRE SPECIALISTS INCORPORATED
Entity Type:Organization
Organization Name:EMPIRE SPECIALISTS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYASINGHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-280-7700
Mailing Address - Street 1:2115 COMPTON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7272
Mailing Address - Country:US
Mailing Address - Phone:626-798-8600
Mailing Address - Fax:626-798-8842
Practice Address - Street 1:82013 DR CARREON BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4832
Practice Address - Country:US
Practice Address - Phone:951-280-7888
Practice Address - Fax:951-372-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty