Healthcare Provider Details

I. General information

NPI: 1801117353
Provider Name (Legal Business Name): LAILA F SIDDIQUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 EAST 44TH STREET COMMUNITY HEALTH CARE
TACOMA WA
98404
US

IV. Provider business mailing address

1019 PACIFIC AVENUE #300 COMMUNITY HEALTH CARE
TACOMA WA
98402
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-4553
  • Fax: 253-474-5395
Mailing address:
  • Phone: 253-722-1540
  • Fax: 253-597-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60334135
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: