Provider Demographics
NPI:1730831462
Name:SIDDIQ, SEIR
Entity type:Individual
Prefix:
First Name:SEIR
Middle Name:
Last Name:SIDDIQ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 ISHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3527
Mailing Address - Country:US
Mailing Address - Phone:510-896-0006
Mailing Address - Fax:
Practice Address - Street 1:3106 ISHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3527
Practice Address - Country:US
Practice Address - Phone:510-896-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000OtherNOT AWARE