Provider Demographics
NPI:1780940536
Name:JARACH, ALAN NMI (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:NMI
Last Name:JARACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 SUNNY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3084
Mailing Address - Country:US
Mailing Address - Phone:415-479-5132
Mailing Address - Fax:415-000-0000
Practice Address - Street 1:83 SUNNY OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3084
Practice Address - Country:US
Practice Address - Phone:415-479-5132
Practice Address - Fax:415-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11450208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice