Basic Information
| Provider Information | |||||||||
| NPI: | 1699758540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIQUEIROS | ||||||||
| FirstName: | ARMANDO | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4460 BROAD ST STE A | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934018064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055976715 | ||||||||
| FaxNumber: | 8055414973 | ||||||||
| Practice Location | |||||||||
| Address1: | 4460 BROAD ST STE A | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934018064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055976715 | ||||||||
| FaxNumber: | 8055414973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G71396 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G713960 | 05 | CA | MEDICAID | FT927Z | 01 | CA | MEDICARE ID | OTHER | 00G713960 | 01 | CA | BLUE SHIELD | OTHER |