Provider Demographics
NPI:1275766156
Name:MEDICAL RESOURCE CENTER OF TARZANA, INC.
Entity Type:Organization
Organization Name:MEDICAL RESOURCE CENTER OF TARZANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-8484
Mailing Address - Street 1:18445 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5324
Mailing Address - Country:US
Mailing Address - Phone:818-708-8484
Mailing Address - Fax:818-881-7451
Practice Address - Street 1:18445 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5324
Practice Address - Country:US
Practice Address - Phone:818-708-8484
Practice Address - Fax:818-881-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80782207R00000X
CA20A8083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty