Provider Demographics
NPI:1770563967
Name:SIDDIQUI, JAVEED (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JAVEED
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DOUGLAS BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4283
Mailing Address - Country:US
Mailing Address - Phone:916-740-3721
Mailing Address - Fax:
Practice Address - Street 1:3400 DOUGLAS BLVD STE 225
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4283
Practice Address - Country:US
Practice Address - Phone:916-740-3721
Practice Address - Fax:916-783-0513
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65726207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A657260OtherMEDI-CAL
CAG95491Medicare UPIN
CA00A657260Medicare ID - Type Unspecified