Provider Demographics
NPI:1619359676
Name:SIDDIQI, MARIA HASEEB (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:HASEEB
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4139
Mailing Address - Country:US
Mailing Address - Phone:817-584-1313
Mailing Address - Fax:
Practice Address - Street 1:5900 W PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-4427
Practice Address - Country:US
Practice Address - Phone:817-478-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09381363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant