Provider Demographics
NPI:1972109775
Name:WEERASINGHE, SANJEEWA KOLITHA (LVN)
Entity Type:Individual
Prefix:
First Name:SANJEEWA
Middle Name:KOLITHA
Last Name:WEERASINGHE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33952 LILY RD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2290
Mailing Address - Country:US
Mailing Address - Phone:909-499-4422
Mailing Address - Fax:
Practice Address - Street 1:33952 LILY RD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2290
Practice Address - Country:US
Practice Address - Phone:909-499-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284394164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse