Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R3383 | TX |
Y | 2080P0204X | Pediatric Emergency Doctor | R3383 | TX |
NPI | 1114332392 |
---|---|
Provider Name | Dr. Divya Mirchandani |
First Address | Houston, TX 77030-3609 |
Second Address | Houston, TX 77030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 29/05/2018 |