Provider Demographics
NPI:1730100330
Name:DESILVA, UDAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:UDAYA
Middle Name:
Last Name:DESILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4037
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-4037
Mailing Address - Country:US
Mailing Address - Phone:661-726-6255
Mailing Address - Fax:661-726-6261
Practice Address - Street 1:623 W AVENUE Q
Practice Address - Street 2:SUITE A
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3890
Practice Address - Country:US
Practice Address - Phone:661-726-6255
Practice Address - Fax:661-726-6261
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48836207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A488360Medicaid
CA00A488360Medicaid
CAWA48836CMedicare PIN