Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A71415 | CA |
NPI | 1972614436 |
---|---|
Provider Name | Shoab Siddique |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Sacramento, CA 95816-7058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 13/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000810579445 | PHCS (01) | CA |
00A714150 | (05) | CA |
079115 | HEALTH NET (01) | CA |
1294175 | GREAT WEST (01) | CA |
1837078 | FIRST HEALTH (01) | CA |
1968751 | UNITED HEALTHCARE (01) | CA |
44530 | INTERPLAN (01) | CA |
7494423 | CIGNA (01) | CA |
7796146 | AETNA (01) | CA |
90138939 | PACIFICARE (01) | CA |
A71415 | BLUE CROSS (01) | CA |
H14985 | (02) | |
MCMG298400 | WESTERN HEALTH ADVANTAGE (01) | CA |