Provider Demographics
NPI:1457713562
Name:SIDDIQUI, RAAHAT
Entity Type:Individual
Prefix:
First Name:RAAHAT
Middle Name:
Last Name:SIDDIQUI
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 1:725 SAWYER PL
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-9488
Mailing Address - Country:US
Mailing Address - Phone:714-723-1680
Mailing Address - Fax:
Practice Address - Street 1:2101 N GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-2828
Practice Address - Country:US
Practice Address - Phone:818-848-8825
Practice Address - Fax:818-848-8826
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-16-6975103K00000X
CA1-22-59383103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst