Basic Information
| Provider Information | |||||||||
| NPI: | 1104093913 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIVYATISH PRIMARY CARE HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3685 | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779033685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615763680 | ||||||||
| FaxNumber: | 3615764219 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E SAN ANTONIO ST STE 304W | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779016040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615763680 | ||||||||
| FaxNumber: | 3615764219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2008 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | JAIN | ||||||||
| AuthorizedOfficialFirstName: | ARUN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3615763680 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L8086 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.