Provider Demographics
NPI:1992098487
Name:RATNAYAKE, DILANGANI (MD)
Entity type:Individual
Prefix:
First Name:DILANGANI
Middle Name:
Last Name:RATNAYAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73733 FRED WARING DR STE 205
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2591
Mailing Address - Country:US
Mailing Address - Phone:760-895-4280
Mailing Address - Fax:760-673-7985
Practice Address - Street 1:73733 FRED WARING DR STE 205
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2591
Practice Address - Country:US
Practice Address - Phone:760-895-4280
Practice Address - Fax:760-408-5817
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59003207L00000X
CAA133925207LP2900X, 208VP0014X
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46-3095558OtherTOBIAS MOELLER-BERTRAM, MD CORPORATION