Provider Demographics
NPI:1619175445
Name:SEDDICK, DIVA S (MD, CM)
Entity Type:Individual
Prefix:DR
First Name:DIVA
Middle Name:S
Last Name:SEDDICK
Suffix:
Gender:F
Credentials:MD, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 COUNTRY CLUB TER
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-6064
Mailing Address - Country:US
Mailing Address - Phone:925-785-5990
Mailing Address - Fax:
Practice Address - Street 1:903 SAN RAMON VALLEY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4049
Practice Address - Country:US
Practice Address - Phone:925-255-5411
Practice Address - Fax:866-374-4490
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62960171400000X, 2083P0901X, 202D00000X, 2080P0204X, 2080N0001X, 208000000X, 207PP0204X
NV137782080N0001X, 2080P0204X, 208M00000X
CAA062960208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine