Provider Demographics
NPI:1922001346
Name:WIJESINGHE, MAPITIYAGE N (MD)
Entity Type:Individual
Prefix:
First Name:MAPITIYAGE
Middle Name:N
Last Name:WIJESINGHE
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 1:174 W LINCOLN AVE
Mailing Address - Street 2:SUITE 582
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2901
Mailing Address - Country:US
Mailing Address - Phone:714-470-3260
Mailing Address - Fax:
Practice Address - Street 1:174 W LINCOLN AVE
Practice Address - Street 2:SUITE 582
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2901
Practice Address - Country:US
Practice Address - Phone:714-470-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2014-03-01
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
CAA33740207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337402Medicaid
CO00A337401Medicaid
CA00A337400Medicaid
CA00A337400Medicaid
CAW19265Medicare PIN
CAWA33740AMedicare PIN