Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A172297 | CA |
NPI | 1003342072 |
---|---|
Provider Name | Faryal Asad Siddiqui |
First Address | La Jolla, CA 92037-4309 |
Second Address | La Jolla, CA 92037-4309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 24/05/2021 |