Provider Demographics
NPI:1770024424
Name:SIDDIQI, ANWER
Entity Type:Individual
Prefix:
First Name:ANWER
Middle Name:
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 W LAMBERT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3921
Mailing Address - Country:US
Mailing Address - Phone:714-494-1320
Mailing Address - Fax:714-990-4099
Practice Address - Street 1:471 W LAMBERT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3921
Practice Address - Country:US
Practice Address - Phone:714-494-1320
Practice Address - Fax:714-990-4099
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies