Provider Demographics
NPI:1013947233
Name:GOONAWARDENA, PATHMANI (MD)
Entity Type:Individual
Prefix:DR
First Name:PATHMANI
Middle Name:
Last Name:GOONAWARDENA
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 1:1000 DELBON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2008
Mailing Address - Country:US
Mailing Address - Phone:209-668-7195
Mailing Address - Fax:209-668-1251
Practice Address - Street 1:1000 DELBON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2008
Practice Address - Country:US
Practice Address - Phone:209-668-7195
Practice Address - Fax:209-668-1251
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7907857Medicare UPIN