Provider Demographics
NPI:1215124771
Name:SIDHOM, TAGHRID RAGHEB (MD)
Entity type:Individual
Prefix:DR
First Name:TAGHRID
Middle Name:RAGHEB
Last Name:SIDHOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:415 W ROUTE 66
Mailing Address - Street 2:202
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4335
Mailing Address - Country:US
Mailing Address - Phone:626-963-4467
Mailing Address - Fax:626-963-9543
Practice Address - Street 1:415 W ROUTE 66
Practice Address - Street 2:202
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4335
Practice Address - Country:US
Practice Address - Phone:626-963-4467
Practice Address - Fax:626-963-9543
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA989202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGF793AMedicare UPIN