Healthcare Provider Details

I. General information

NPI: 1659298743
Provider Name (Legal Business Name): SIDNEY HA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6378 COMMERCE BLVD
ROHNERT PARK CA
94928-2404
US

IV. Provider business mailing address

900 FOLSOM ST APT 445
SAN FRANCISCO CA
94107-2170
US

V. Phone/Fax

Practice location:
  • Phone: 707-586-3494
  • Fax:
Mailing address:
  • Phone: 916-842-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH92470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: