Healthcare Provider Details

I. General information

NPI: 1093484834
Provider Name (Legal Business Name): SIYAN CLINICAL RESEARCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 TESCONI CIR STE B
SANTA ROSA CA
95401-4691
US

IV. Provider business mailing address

480 TESCONI CIR STE B
SANTA ROSA CA
95401-4691
US

V. Phone/Fax

Practice location:
  • Phone: 707-206-7268
  • Fax: 707-206-7254
Mailing address:
  • Phone: 707-206-7268
  • Fax: 707-206-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ANISH SHAH
Title or Position: OWNER
Credential:
Phone: 707-206-7268