Provider Demographics
NPI:1992577910
Name:HARAKA, AMAL BADR
Entity type:Individual
Prefix:MS
First Name:AMAL
Middle Name:BADR
Last Name:HARAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 SHORELINE DR UNIT 4206
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4918
Mailing Address - Country:US
Mailing Address - Phone:202-656-5556
Mailing Address - Fax:
Practice Address - Street 1:7160 SHORELINE DR UNIT 4206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-4918
Practice Address - Country:US
Practice Address - Phone:202-656-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist