Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A76771 | CA |
NPI | 1740367903 |
---|---|
Provider Name | Dr. Dineshi Lasitha Liyanage |
First Address | Fresno, CA 93729-5042 |
Second Address | Fresno, CA 93720-2992 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I01511 | (02) |