Provider Demographics
NPI:1164088696
Name:WIJEGUNARATNE, HESHAN (MHS, RADT-I)
Entity Type:Individual
Prefix:
First Name:HESHAN
Middle Name:
Last Name:WIJEGUNARATNE
Suffix:
Gender:M
Credentials:MHS, RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4527
Mailing Address - Country:US
Mailing Address - Phone:626-791-0831
Mailing Address - Fax:626-791-1592
Practice Address - Street 1:3085 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4527
Practice Address - Country:US
Practice Address - Phone:626-791-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)