Healthcare Provider Details

I. General information

NPI: 1619363314
Provider Name (Legal Business Name): AMINAA SIDDIQI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 03/07/2023
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 W COVELL BLVD STE 104
DAVIS CA
95616-5671
US

IV. Provider business mailing address

2SOUTH310 ROUTE 59
WARRENVILLE IL
60555-1280
US

V. Phone/Fax

Practice location:
  • Phone: 530-747-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number036.153084
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA153858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: