Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | R4244 | TX |
NPI | 1003176975 |
---|---|
Provider Name | Divyaswapnika Javvaji |
First Address | Coppell, TX 75019-5066 |
Second Address | Coppell, TX 75019-5066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 17/07/2019 |