Provider Demographics
NPI:1124385547
Name:SIDHU, DIVYA ULLAL (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:ULLAL
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:568 E HERNDON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2989
Mailing Address - Country:US
Mailing Address - Phone:559-251-7505
Mailing Address - Fax:
Practice Address - Street 1:568 E HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2989
Practice Address - Country:US
Practice Address - Phone:559-224-7990
Practice Address - Fax:559-224-5617
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA170542208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics