Provider Demographics
NPI:1740300409
Name:SIDDIQ, MANAL (MS, IMF)
Entity type:Individual
Prefix:MRS
First Name:MANAL
Middle Name:
Last Name:SIDDIQ
Suffix:
Gender:F
Credentials:MS, IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10815 CAMINITO ARCADA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3666
Mailing Address - Country:US
Mailing Address - Phone:510-206-1099
Mailing Address - Fax:
Practice Address - Street 1:7339 EL CAJON BLVD STE K
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3435
Practice Address - Country:US
Practice Address - Phone:619-668-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health