Provider Demographics
NPI:1487925186
Name:CHANDRATILLAKE, GEMMA LOUISE (MPHIL PHD MS CGC)
Entity type:Individual
Prefix:DR
First Name:GEMMA
Middle Name:LOUISE
Last Name:CHANDRATILLAKE
Suffix:
Gender:F
Credentials:MPHIL PHD MS CGC
Other - Prefix:
Other - First Name:GEMMA
Other - Middle Name:LOUISE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 WILLOW RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1540
Mailing Address - Country:US
Mailing Address - Phone:650-752-1300
Mailing Address - Fax:
Practice Address - Street 1:1350 WILLOW RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1540
Practice Address - Country:US
Practice Address - Phone:650-752-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2013-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGC000379OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH GENETIC DISEASE SCREENING PROGRAM