Healthcare Provider Details

I. General information

NPI: 1639136344
Provider Name (Legal Business Name): NATASHA SIDDIQUI CONLEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATASHA SIDDIQUI D.O.

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 BUNKER HILL DRIVE KAISER PERMANENTE
SAN DIEGO CA
92109
US

IV. Provider business mailing address

13405 MARCASEL PL
SAN DIEGO CA
92130-1207
US

V. Phone/Fax

Practice location:
  • Phone: 773-960-0302
  • Fax:
Mailing address:
  • Phone: 773-960-0302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036114650
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A9388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: