Healthcare Provider Details

I. General information

NPI: 1639796873
Provider Name (Legal Business Name): EVAN NIAKAMAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2020
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E VALLEY PKWY STE 311
ESCONDIDO CA
92025-3374
US

IV. Provider business mailing address

16 CALLE ALIMAR
RANCHO SANTA MARGARITA CA
92688-2318
US

V. Phone/Fax

Practice location:
  • Phone: 760-520-8340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: