Provider Demographics
NPI:1710718945
Name:LOTUS CENTER FOR RESILIENCE
Entity type:Organization
Organization Name:LOTUS CENTER FOR RESILIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIJESEKERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:951-479-6400
Mailing Address - Street 1:16055 VENTURA BLVD STE 809
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2610
Mailing Address - Country:US
Mailing Address - Phone:310-800-7112
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 809
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2610
Practice Address - Country:US
Practice Address - Phone:310-800-7112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOTUS CENTER FOR RESILIENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty