Healthcare Provider Details

I. General information

NPI: 1972936755
Provider Name (Legal Business Name): SALEM HARAKE M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18445 VANOWEN ST
RESEDA CA
91335-5324
US

IV. Provider business mailing address

18445 VANOWEN ST
RESEDA CA
91335-5324
US

V. Phone/Fax

Practice location:
  • Phone: 818-708-8484
  • Fax: 818-881-7451
Mailing address:
  • Phone: 818-708-8484
  • Fax: 818-881-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA80782
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA80782
License Number StateCA

VIII. Authorized Official

Name: DR. SALEM NOUR HARAKE
Title or Position: PHYSICIAN/CEO/OWNER
Credential: M.D.
Phone: 818-708-8484