| Doctor Name: | SHAFI ULLAH SIDDIQI |
| NPI Number: | 1538499470 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | A102176 |
| Business Practice Address: | 425 Diamond Dr Ste 102 Lake Elsinore, CA - 925304495 |
| Business Phone Number: | 9512260866 |
| Business Fax Number: | 9512260868 |
| Mailing Address: | 18721 Paseo Picasso, IRVINE |
| State: | CA |
| Postal Code: | 926033328 |
| Phone Number: | 9495107759 |
| Fax Number: | 9512260868 |
| NPI Enumeration Date: | 12/27/2009 |
| NPI Last Update Date: | 06/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A102176 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |