Individual
REBECCA SIDDIQUI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4113 W HAYWARD AVE, PHOENIX, AZ 85051-5751
(623) 336-7568
(623) 399-8915
Mailing address
7212 W MCRAE WAY, GLENDALE, AZ 85308-5837
(602) 332-0780
(623) 399-8915
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AL8880H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
926240
—
AZ
Enumeration date
10/28/2014
Last updated
10/28/2014
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