Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 227916 | MA |
N | 111NI0900X | Internist | 227916 | MA |
N | 207R00000X | Internist | A107162 | CA |
N | 111NI0900X | Internist | A107162 | CA |
Y | 207RH0000X | Hematologist | A107162 | CA |
NPI | 1467408948 |
---|---|
Provider Name | Dr. Tanya Siddiqi |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 11/11/2020 |