Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A30538 | CA |
NPI | 1417039371 |
---|---|
Provider Name | Sunil Pushpakumara Perera |
First Address | Roseville, CA 95678-1340 |
Second Address | Roseville, CA 95678-1340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A26142 | (02) | CA |
ZZZ7673Z | (05) | CA |