Provider Demographics
NPI:1639255854
Name:ARROWHEAD NEUROSURGICAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ARROWHEAD NEUROSURGICAL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ANMG, INC.
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-486-4460
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0685
Mailing Address - Country:US
Mailing Address - Phone:951-486-4460
Mailing Address - Fax:951-486-6510
Practice Address - Street 1:26520 CACTUS AVE STE A2006
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-4460
Practice Address - Fax:951-486-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR010238Medicaid
CAZZZ31219ZMedicare ID - Type Unspecified