Provider Demographics
NPI:1902836190
Name:JAYARATNA, MAHINDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHINDA
Middle Name:A
Last Name:JAYARATNA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4510 E PACIFIC COAST HWY
Mailing Address - Street 2:ROOM 605
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3279
Mailing Address - Country:US
Mailing Address - Phone:562-346-1114
Mailing Address - Fax:562-961-7606
Practice Address - Street 1:4510 E PACIFIC COAST HWY
Practice Address - Street 2:ROOM 605
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3279
Practice Address - Country:US
Practice Address - Phone:562-346-1114
Practice Address - Fax:562-961-7606
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA425112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E09259Medicare UPIN