Provider Demographics
NPI:1700122215
Name:BARAK, RINA
Entity type:Individual
Prefix:MRS
First Name:RINA
Middle Name:
Last Name:BARAK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RINA
Other - Middle Name:
Other - Last Name:ROME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16500 VENTURA BLVD. SUITE 414
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-788-1003
Mailing Address - Fax:
Practice Address - Street 1:16500 VENTURA BLVD STE 414
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-5050
Practice Address - Country:US
Practice Address - Phone:818-788-1003
Practice Address - Fax:818-788-1135
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPE7365OtherSPEECH PATHOLOGY