Healthcare Provider Details

I. General information

NPI: 1265924831
Provider Name (Legal Business Name): GULNAZBANU R SIDDIQUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SUTTER ST STE 120150
SAN FRANCISCO CA
94104-9000
US

IV. Provider business mailing address

2443 HANSON DR
FAIRFIELD CA
94533-8838
US

V. Phone/Fax

Practice location:
  • Phone: 707-416-3531
  • Fax:
Mailing address:
  • Phone: 707-416-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028738
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: