Provider Demographics
NPI:1174630404
Name:HAROUN, ANSAR M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANSAR
Middle Name:M
Last Name:HAROUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5475 BRAGG ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4103
Mailing Address - Country:US
Mailing Address - Phone:619-531-3065
Mailing Address - Fax:619-531-3668
Practice Address - Street 1:220 W BROADWAY
Practice Address - Street 2:FORENSIC PSYCHIATRY CLINIC # 1003
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3886
Practice Address - Country:US
Practice Address - Phone:619-531-3065
Practice Address - Fax:619-531-3668
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA432602084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry