Provider Demographics
NPI:1881688356
Name:GOONESINGHE, IRESHA C (MD)
Entity Type:Individual
Prefix:DR
First Name:IRESHA
Middle Name:C
Last Name:GOONESINGHE
Suffix:
Gender:F
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 340457
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-0457
Mailing Address - Country:US
Mailing Address - Phone:760-383-3040
Mailing Address - Fax:
Practice Address - Street 1:301 DRUMMOND AVE
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3187
Practice Address - Country:US
Practice Address - Phone:760-371-3008
Practice Address - Fax:760-371-3009
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061625207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770569362OtherTAX ID
CA00A616250Medicare ID - Type Unspecified