Provider Demographics
NPI:1457913485
Name:CHAYAWATNA, DAVID ERESO (FNP-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ERESO
Last Name:CHAYAWATNA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24932 AVENIDA BALITA
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3030
Mailing Address - Country:US
Mailing Address - Phone:661-904-9081
Mailing Address - Fax:
Practice Address - Street 1:27550 NEWHALL RANCH RD STE 203
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-6049
Practice Address - Country:US
Practice Address - Phone:661-251-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011991363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner