Individual
DR. CLERA SUSAN WIJEWARDENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1397 E LOS ANGELES AVE, SIMI VALLEY, CA 93065-2866
(805) 527-8991
Mailing address
11845 STONE GATE WAY, PORTER RANCH, CA 91326-4033
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
37754
CA
Other
Enumeration date
01/15/2007
Last updated
07/08/2007
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