Provider Demographics
NPI:1891223210
Name:HEMARAJATA, PEERA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEERA
Middle Name:
Last Name:HEMARAJATA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 GREEN VALLEY CIR APT 111
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7012
Mailing Address - Country:US
Mailing Address - Phone:424-394-5929
Mailing Address - Fax:
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6511
Practice Address - Country:US
Practice Address - Phone:310-794-2720
Practice Address - Fax:310-794-2765
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTE00102040207ZM0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology