05D0888209 CLIA NUMBER - GEORGE M JAYATILAKA MD INC

Laboratory Demographics

CLIA Number: 05D0888209

Facility Name: GEORGE M JAYATILAKA MD INC

Facility Address:
1760 TERMINO AVE #116
LONG BEACH, CA
ZIP 90804
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Facility Phone Number: 310 597-8885

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619420031

Taxonomy: 225400000X - Rehabilitation Practitioner
A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.

CLIA Record

Field Name	Field Value
CLIA Number	05D0888209
LAB Type	Physician Office
Facility Name	GEORGE M JAYATILAKA MD INC
Street	1760 TERMINO AVE #116
City	LONG BEACH
State	CA
ZIP	90804
Phone	310 597-8885
CertificateType	4
CertificateEffectiveDate	1/25/2024
CertificateExpirationDate	1/24/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024