Organization
SHAFI SIDDIQI MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS BRIGETTE JACKSON (CREDENTIALING SPECIALIST)
(951) 667-0817
Entity
Organization
Contact information
Practice address
31569 CANYON ESTATES DR STE 201, LAKE ELSINORE, CA 92532-0475
(951) 226-0866
(951) 226-0868
Mailing address
31569 CANYON ESTATES DR STE 201, LAKE ELSINORE, CA 92532-0475
(951) 226-0866
(951) 226-0868
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/17/2021
Last updated
08/17/2021
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