Provider Demographics
NPI:1639796873
Name:NIAKAMAL, EVAN
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:NIAKAMAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CALLE ALIMAR
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3409 CALLOWAY DR UNIT 601
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2534
Practice Address - Country:US
Practice Address - Phone:661-589-1200
Practice Address - Fax:661-589-7200
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-04
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant