Provider Demographics
NPI:1699179846
Name:BARAK, ALANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALANNA
Middle Name:
Last Name:BARAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 WILSHIRE BLVD STE 418
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2113
Mailing Address - Country:US
Mailing Address - Phone:323-864-0909
Mailing Address - Fax:
Practice Address - Street 1:9735 WILSHIRE BLVD STE 418
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2113
Practice Address - Country:US
Practice Address - Phone:323-864-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23018128282E00000X, 363A00000X, 281P00000X, 363AM0700X, 363AS0400X
CA55187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No282E00000XHospitalsLong Term Care Hospital
No281P00000XHospitalsChronic Disease Hospital
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical