Provider Demographics
NPI:1407883952
Name:BURACK, HERBERT
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:
Last Name:BURACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27995 PALOS VERDES DR E
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5152
Mailing Address - Country:US
Mailing Address - Phone:310-833-1625
Mailing Address - Fax:
Practice Address - Street 1:27995 PALOS VERDES DRIVE EAST
Practice Address - Street 2:3565 DEL AMO BLVD
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-214-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9145174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist