Provider Demographics
NPI:1760977060
Name:MARIA SIU APC
Entity Type:Organization
Organization Name:MARIA SIU APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-622-5654
Mailing Address - Street 1:160 E ARTESIA ST STE 330
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2922
Mailing Address - Country:US
Mailing Address - Phone:909-622-5654
Mailing Address - Fax:909-622-4914
Practice Address - Street 1:160 E ARTESIA ST STE 330
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-622-5654
Practice Address - Fax:909-622-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13839207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty