MEDICARE: HAEMOKINETICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	242T00000X	Perfusionist	NONE

General Provider Information

NPI Number	:	1588967939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAEMOKINETICS LLC

Provider Business Mailing Address
First Line	:	1981 SCENIC RIDGE DR
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1004
Country	:	US
Telephone Number	:	714-269-4066
Fax Number	:	909-591-8343

Provider Business Practice Location Address
First Line	:	1981 SCENIC RIDGE DR
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1004
Country	:	US
Telephone Number	:	714-269-4066
Fax Number	:	909-591-8343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDY DEAN MILLER
Credential	:	CERT. PERFUSIONIST
Telephone Number	:	714-269-4066

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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Directions to “HAEMOKINETICS LLC ” Practice Location

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