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General NPI Number Information
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NPI Number | 1891223210
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Entity Type | Individual
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Provider Name | PEERA HEMARAJATA PHD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 11633 SAN VICENTE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90049-6511
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Country | US
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Telephone | 310-794-2720
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Fax | 310-794-2765
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Provider Business Mailing Address
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Address Line | 6500 GREEN VALLEY CIR APT 111
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City | CULVER CITY
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State | CA
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Zip | 90230-7012
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Country | US
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Telephone | 424-394-5929
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZM0300X
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Taxonomy Name | Medical Microbiology Physician
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License Number | MTE00102040
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License Number State | CA
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