Provider Demographics
NPI:1932922630
Name:JAYASEKERA, LINGEE (BACHELORDEGREE)
Entity type:Individual
Prefix:MR
First Name:LINGEE
Middle Name:
Last Name:JAYASEKERA
Suffix:
Gender:F
Credentials:BACHELORDEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 SHERINGTON PL APT 1031755
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-6053
Mailing Address - Country:US
Mailing Address - Phone:949-449-4767
Mailing Address - Fax:
Practice Address - Street 1:1755 SHERINGTON PL APT 1031755
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-6053
Practice Address - Country:US
Practice Address - Phone:949-449-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist