Provider Demographics
NPI:1831118934
Name:WICKRAMASINGHE, HIMANSHU VAJRIN (MD)
Entity Type:Individual
Prefix:
First Name:HIMANSHU
Middle Name:VAJRIN
Last Name:WICKRAMASINGHE
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 1:23928 LYONS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2409
Mailing Address - Country:US
Mailing Address - Phone:661-254-7216
Mailing Address - Fax:661-254-4830
Practice Address - Street 1:23928 LYONS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2409
Practice Address - Country:US
Practice Address - Phone:661-254-7216
Practice Address - Fax:661-254-4830
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56078207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH68728Medicare UPIN