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333 N Sunset Ave West Covina CA 91790 | |
| (626) 960-5461 | |
| (626) 962-7199 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 333 N Sunset Ave, West Covina, California |
| Authorized Official Name and Position | Sisira K Gunawardane (PRESIDENT OF CORPORATION) |
| Authorized Official Contact | 6269605461 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
333 N Sunset Ave West Covina CA 91790 Ph: (626) 960-5461 | 333 N Sunset Ave West Covina CA 91790 Ph: (626) 960-5461 |
| NPI Number | 1922160845 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 12/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922160845 | NPI | - | NPPES |
| GR0095500 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A33761 (California) | Primary |
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