Provider Demographics
NPI:1518302835
Name:DIVAKER PEDIATRICS LLC
Entity Type:Organization
Organization Name:DIVAKER PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-614-0980
Mailing Address - Street 1:6551 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7013
Mailing Address - Country:US
Mailing Address - Phone:609-614-0980
Mailing Address - Fax:609-784-7474
Practice Address - Street 1:6551 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-7013
Practice Address - Country:US
Practice Address - Phone:609-614-0980
Practice Address - Fax:609-784-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty