Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | A75933 | CA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | A75933 | CA |
N | 2081P2900X | Pain Medicine | A75933 | CA |
NPI | 1447347950 |
---|---|
Provider Name | Dr. Barak Mevorak |
First Address | Encino, CA 91436-2124 |
Second Address | Encino, CA 91436-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H98820 | (02) | CA |