Healthcare Provider Details

I. General information

NPI: 1992577910
Provider Name (Legal Business Name): MS. AMAL BADR HARAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 SHORELINE DR UNIT 4206
SAN DIEGO CA
92122-4918
US

IV. Provider business mailing address

7160 SHORELINE DR UNIT 4206
SAN DIEGO CA
92122-4918
US

V. Phone/Fax

Practice location:
  • Phone: 202-656-5556
  • Fax:
Mailing address:
  • Phone: 202-656-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: