Provider Demographics
NPI:1275308579
Name:GARG, DIVYA HIMANGI (MPH, RDN)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:HIMANGI
Last Name:GARG
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:DIVYA
Other - Middle Name:HIMANGI
Other - Last Name:PAHWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RDN
Mailing Address - Street 1:10241 NW LANGWORTHY TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8168
Mailing Address - Country:US
Mailing Address - Phone:503-974-6285
Mailing Address - Fax:
Practice Address - Street 1:10241 NW LANGWORTHY TER
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-8168
Practice Address - Country:US
Practice Address - Phone:503-974-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD-10212406133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty