Provider Demographics
NPI:1467594838
Name:BARAK, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:BARAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1911 FOOTHILL BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3516
Mailing Address - Country:US
Mailing Address - Phone:909-596-5900
Mailing Address - Fax:909-596-1655
Practice Address - Street 1:1911 FOOTHILL BLVD
Practice Address - Street 2:STE A
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3516
Practice Address - Country:US
Practice Address - Phone:909-596-5900
Practice Address - Fax:909-596-1655
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74472207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G744720Medicaid
E56937Medicare UPIN
CA00G744720Medicaid