Provider Demographics
NPI:1750622650
Name:NAWAZ, SIDDIQA (MD)
Entity type:Individual
Prefix:
First Name:SIDDIQA
Middle Name:
Last Name:NAWAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N SAN JACINTO ST
Mailing Address - Street 2:STE P
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3154
Mailing Address - Country:US
Mailing Address - Phone:951-816-5105
Mailing Address - Fax:
Practice Address - Street 1:540 N SAN JACINTO ST STE P
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3154
Practice Address - Country:US
Practice Address - Phone:951-929-4000
Practice Address - Fax:951-929-4100
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284852207R00000X
CAA162872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine