Basic Information
| Provider Information | |||||||||
| NPI: | 1962949354 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHMED | ||||||||
| FirstName: | WAHEEDA | ||||||||
| MiddleName: | SIDDIQUI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 729 SUNRISE AVE STE 611 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956614548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232104569 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18185 N 83RD AVE STE 107 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853080520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235830306 | ||||||||
| FaxNumber: | 6235831349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2017 | ||||||||
| LastUpdateDate: | 03/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 95008627 | AZ | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 363LF0000X | AP9985 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.