Provider Demographics
NPI:1255023214
Name:VITHARANA PATHIRANA, MAHESH INDRAJITH (CMT)
Entity type:Individual
Prefix:MR
First Name:MAHESH
Middle Name:INDRAJITH
Last Name:VITHARANA PATHIRANA
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 VILLA AVE APT 138
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0868
Mailing Address - Country:US
Mailing Address - Phone:559-581-2517
Mailing Address - Fax:
Practice Address - Street 1:7525 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2614
Practice Address - Country:US
Practice Address - Phone:559-581-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty