Provider Demographics
NPI:1083870679
Name:HEMATECK LLC
Entity Type:Organization
Organization Name:HEMATECK LLC
Other - Org Name:HEMATECK LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HEMA
Authorized Official - Middle Name:ASOKA
Authorized Official - Last Name:RATNAYAKE
Authorized Official - Suffix:
Authorized Official - Credentials:B SC MED MICRO
Authorized Official - Phone:626-334-2000
Mailing Address - Street 1:752 N LOREN AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2255
Mailing Address - Country:US
Mailing Address - Phone:626-334-2000
Mailing Address - Fax:626-334-2001
Practice Address - Street 1:752 N LOREN AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2255
Practice Address - Country:US
Practice Address - Phone:626-334-2000
Practice Address - Fax:626-334-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-02
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00339084291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory