Basic Information
| Provider Information | |||||||||
| NPI: | 1124595608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARI | ||||||||
| FirstName: | DIVYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3263 TRAJAN COURT | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086930790 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3650 MT DIABLO BLVD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106659700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2018 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.