Healthcare Provider Details

I. General information

NPI: 1104575091
Provider Name (Legal Business Name): HARIS GHAYUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

905 MADONNA RD UNIT 24
SAN LUIS OBISPO CA
93405-6572
US

V. Phone/Fax

Practice location:
  • Phone: 805-468-2000
  • Fax:
Mailing address:
  • Phone: 512-745-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71841
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: