Healthcare Provider Details

I. General information

NPI: 1053203869
Provider Name (Legal Business Name): BARAKAT SIEL VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E 5TH AVE STE 247
EUGENE OR
97401-0003
US

IV. Provider business mailing address

207 E 5TH AVE STE 247
EUGENE OR
97401-0003
US

V. Phone/Fax

Practice location:
  • Phone: 503-459-3323
  • Fax:
Mailing address:
  • Phone: 503-459-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUZETTE BARAKAT
Title or Position: PHYSICIAN
Credential: MD MPH
Phone: 503-459-3323