Provider Demographics
NPI:1699985796
Name:RODRIGO, PULAHINGE DHANAPALA (MD)
Entity type:Individual
Prefix:DR
First Name:PULAHINGE
Middle Name:DHANAPALA
Last Name:RODRIGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13581 BELLE RIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2829
Mailing Address - Country:US
Mailing Address - Phone:714-544-5653
Mailing Address - Fax:714-544-3189
Practice Address - Street 1:280 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3852
Practice Address - Country:US
Practice Address - Phone:714-704-1900
Practice Address - Fax:714-704-1912
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37525207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A37525Medicaid
CABH335Medicare PIN