Provider Demographics
NPI:1306149562
Name:OAKS INTERNAL MEDICINE, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:OAKS INTERNAL MEDICINE, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASRA
Authorized Official - Middle Name:S I
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-375-6000
Mailing Address - Street 1:3295 OLD CONEJO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2152
Mailing Address - Country:US
Mailing Address - Phone:805-375-6000
Mailing Address - Fax:805-375-0011
Practice Address - Street 1:3295 OLD CONEJO ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2152
Practice Address - Country:US
Practice Address - Phone:805-375-6000
Practice Address - Fax:805-375-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty