Provider Demographics
NPI:1215017223
Name:HARAKE, BILAL (MD)
Entity Type:Individual
Prefix:
First Name:BILAL
Middle Name:
Last Name:HARAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92674-1359
Mailing Address - Country:US
Mailing Address - Phone:949-492-3514
Mailing Address - Fax:949-366-2390
Practice Address - Street 1:2425 BATH ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4324
Practice Address - Country:US
Practice Address - Phone:805-569-3146
Practice Address - Fax:805-569-0786
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA444452080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A444451Medicaid