Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 535195 | CA |
NPI | 1275678591 |
---|---|
Provider Name | Mr. Sunjeeve Prasana Weerasinghe |
First Address | San Bernardino, CA 92408-4178 |
Second Address | Loma Linda, CA 92354-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |