Provider Demographics
NPI:1760132377
Name:JAYASEKERA, SUVINI (LAC)
Entity Type:Individual
Prefix:
First Name:SUVINI
Middle Name:
Last Name:JAYASEKERA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22027 BALTAR ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3823
Mailing Address - Country:US
Mailing Address - Phone:805-570-5600
Mailing Address - Fax:
Practice Address - Street 1:17000 VENTURA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4149
Practice Address - Country:US
Practice Address - Phone:818-854-5884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist