Individual
DR. SHANTI SIDDIQUI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
609 NEW YORK RANCH RD, JACKSON, CA 95642-9328
(209) 257-0311
(209) 257-0302
Mailing address
609 NEW YORK RANCH RD, JACKSON, CA 95642-9328
(209) 257-0311
(209) 257-0302
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
C51834
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C518340
—
CA
Enumeration date
10/24/2006
Last updated
07/08/2007
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