Provider Demographics
NPI:1760636864
Name:EVCIMEN, HARUN (MD)
Entity Type:Individual
Prefix:
First Name:HARUN
Middle Name:
Last Name:EVCIMEN
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 1:1 MAIN ST. H-UNIT YARD TELE PSYCHIATRY
Mailing Address - Street 2:CDCR SAN QUETIN STATE PRISON
Mailing Address - City:SAN QUENTIN
Mailing Address - State:CA
Mailing Address - Zip Code:94964
Mailing Address - Country:US
Mailing Address - Phone:415-454-1460
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST. H-UNIT YARD TELE PSYCHIATRY
Practice Address - Street 2:CDCR SAN QUETIN STATE PRISON
Practice Address - City:SAN QUENTIN
Practice Address - State:CA
Practice Address - Zip Code:94964
Practice Address - Country:US
Practice Address - Phone:415-454-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD669712084P0800X
CAA1195632084P0800X
PAMD4427242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry