Provider Demographics
NPI:1114332392
Name:MIRCHANDANI, DIVYA
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:MIRCHANDANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN STREET
Mailing Address - Street 2:SUITE JJL 341
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3609
Mailing Address - Country:US
Mailing Address - Phone:713-500-7412
Mailing Address - Fax:713-500-0758
Practice Address - Street 1:6431 FANNIN ST STE JJL 431
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-500-7878
Practice Address - Fax:713-500-0758
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3383208000000X, 2080P0204X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program