Provider Demographics
NPI:1982773834
Name:SIDDHAYE CORPORATION
Entity type:Organization
Organization Name:SIDDHAYE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-247-3501
Mailing Address - Street 1:12818 HEACOCK ST
Mailing Address - Street 2:STE C 5
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3173
Mailing Address - Country:US
Mailing Address - Phone:951-247-3501
Mailing Address - Fax:951-243-1702
Practice Address - Street 1:12818 HEACOCK ST
Practice Address - Street 2:STE C 5
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3173
Practice Address - Country:US
Practice Address - Phone:951-247-3501
Practice Address - Fax:951-243-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY454733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0563177OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA454730Medicaid
1982773834OtherNPI
1982773834OtherNPI