Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | A125774 | CA |
NPI | 1053471318 |
---|---|
Provider Name | Dr. Divya Tiwari Koura |
First Address | La Jolla, CA 92093-0960 |
Second Address | La Jolla, CA 92093-1013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2006 |
Last Update Date | 29/03/2018 |