Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A69121 | CA |
NPI | 1023018389 |
---|---|
Provider Name | Dr. Ruwanthi Samaranayake Campano |
First Address | Palmdale, CA 93551-1465 |
Second Address | Palmdale, CA 93551-1465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 25/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A691210 | (05) | CA |
H58655 | (02) |