Healthcare Provider Details

I. General information

NPI: 1528487055
Provider Name (Legal Business Name): HANNA SIDDIQUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2014
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UCLA MEDICAL PLZ STE 265
LOS ANGELES CA
90095-8344
US

IV. Provider business mailing address

5767 W CENTURY BLVD
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0867
  • Fax: 310-206-4855
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA148224
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA148224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: