Healthcare Provider Details

I. General information

NPI: 1437509981
Provider Name (Legal Business Name): SIDDARTH VARUN ARYA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-2598
  • Fax: 714-834-4445
Mailing address:
  • Phone: 714-834-2598
  • Fax: 714-834-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number806020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: