Provider Demographics
NPI:1447347950
Name:MEVORAK, BARAK (MD)
Entity type:Individual
Prefix:DR
First Name:BARAK
Middle Name:
Last Name:MEVORAK
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 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE #775
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-788-2237
Mailing Address - Fax:818-386-0967
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE #775
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-788-2237
Practice Address - Fax:818-386-0967
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75933204C00000X, 208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75933Medicare ID - Type Unspecified
CAH98820Medicare UPIN