Provider Demographics
NPI:1972936755
Name:SALEM HARAKE M.D., INC.
Entity Type:Organization
Organization Name:SALEM HARAKE M.D., INC.
Other - Org Name:DBA: PARS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEM
Authorized Official - Middle Name:NOUR
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:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80782207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0586239Medicaid
CAWA80782AOtherMEDICARE ID
CA00A807820Medicaid
CAH73550Medicare UPIN