Individual
KEERTHI R DE SILVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1141 W REDONDO BEACH BLVD, SUITE 107, GARDENA, CA 90247-3586
(310) 515-0677
(310) 515-5033
Mailing address
1141 W REDONDO BEACH BLVD, SUITE 107, GARDENA, CA 90247-3586
(310) 515-0677
(310) 515-5033
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A30035
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A300350
—
CA
Enumeration date
07/13/2005
Last updated
03/28/2008
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