Healthcare Provider Details

I. General information

NPI: 1699179846
Provider Name (Legal Business Name): ALANNA BARAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD STE 418
BEVERLY HILLS CA
90212-2113
US

IV. Provider business mailing address

9735 WILSHIRE BLVD STE 418
BEVERLY HILLS CA
90212-2113
US

V. Phone/Fax

Practice location:
  • Phone: 323-864-0909
  • Fax:
Mailing address:
  • Phone: 323-864-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number23018128
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23018128
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number23018128
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number23018128
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number23018128
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: