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General NPI Number Information
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NPI Number | 1861056251
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Entity Type | Individual
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Provider Name | MOHAMMED SIDDIQUI MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 1500 DUARTE RD
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City | DUARTE
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State | CA
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Zip | 91010-3012
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Country | US
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Telephone | 626-256-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 W CARSON ST
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City | TORRANCE
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State | CA
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Zip | 90502-2059
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A193169
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License Number State | CA
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