Provider Demographics
NPI:1992979702
Name:R. NIHAL GOONETILLEKE INC.
Entity type:Organization
Organization Name:R. NIHAL GOONETILLEKE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RANJIT
Authorized Official - Middle Name:NIHAL
Authorized Official - Last Name:GOONETILLEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-973-8522
Mailing Address - Street 1:999 N. TUSTIN AVE.
Mailing Address - Street 2:224
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6506
Mailing Address - Country:US
Mailing Address - Phone:714-973-8522
Mailing Address - Fax:
Practice Address - Street 1:999 N. TUSTIN AVE.
Practice Address - Street 2:224
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6506
Practice Address - Country:US
Practice Address - Phone:714-973-8522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32430207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A324300Medicaid
CA00A324300Medicaid