DR. AMILA VIMARA NISSANKA MD NPI 1073023594

NPI Information

  • NPI: 1073023594
  • Provider Name: DR. AMILA VIMARA NISSANKA, MD
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 303 BROADWAY ST STE 103
    LAGUNA BEACH, CA
    ZIP 92651
  • Phone: (949) 665-6000

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NPI Details

DR. Amila Vimara Nissanka, MD is a family medicine in Laguna Beach, CA with 11 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Amila Vimara Nissanka, MD NPI is 1073023594. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

303 BROADWAY ST STE 103
LAGUNA BEACH, CA
ZIP 92651-816
Phone: (949) 665-6000
Fax: (949) 670-4967

The NPI 1073023594 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/10/2017 and was last updated on 5/4/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine125071582ILLINOISNo
2207Q00000XFamily Medicine036.157093ILLINOISNo
3207Q00000XFamily Medicine74854-20WISCONSINNo
4207Q00000XFamily Medicine63792ARIZONANo
5207Q00000XFamily Medicine45836ALABAMANo
6208600000XSurgery125071582ILLINOISNo
7207Q00000XFamily MedicineA174462CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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