Provider Demographics
NPI:1255459756
Name:FERNANDO, KURUKULASOORIYA (MD)
Entity type:Individual
Prefix:DR
First Name:KURUKULASOORIYA
Middle Name:
Last Name:FERNANDO
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 1:19491 MOUNT JASPER DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-1903
Mailing Address - Country:US
Mailing Address - Phone:510-727-0118
Mailing Address - Fax:
Practice Address - Street 1:801 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3871
Practice Address - Country:US
Practice Address - Phone:925-946-1080
Practice Address - Fax:925-946-9717
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98088208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA98088OtherMEDICAL LICENSE