Provider Demographics
NPI:1982848347
Name:BARRACK, HERBERT JOSEPH (CPO)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:JOSEPH
Last Name:BARRACK
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 JACKSON DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3012
Mailing Address - Country:US
Mailing Address - Phone:619-667-7000
Mailing Address - Fax:619-667-4315
Practice Address - Street 1:5360 JACKSON DR STE 110
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3012
Practice Address - Country:US
Practice Address - Phone:619-667-7000
Practice Address - Fax:619-667-4315
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO1213335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier