Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A42411 | CA |
NPI | 1265473730 |
---|---|
Provider Name | Mr. Divyang Natverial Trivedi |
First Address | Norwalk, CA 90650-4107 |
Second Address | Norwalk, CA 90650-4107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 10/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C35536 | (02) | |
OOA424110 | (05) | CA |