Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME76329 | FL |
N | 2080P0203X | Pediatric Critical Care Doctor | ME0076329 | FL |
NPI | 1215074513 |
---|---|
Provider Name | Sudhira Kulatunga |
First Address | Coral Gables, FL 33146 |
Second Address | Coral Gables, FL 33146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 05/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
256581100 | (05) | FL |
46717 | BC BS ID NUMBER (01) | FL |