Provider Demographics
NPI:1891330254
Name:KAKAIYA, DIVYA (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:KAKAIYA
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 OBERLIN DR STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1739
Mailing Address - Country:US
Mailing Address - Phone:858-622-0221
Mailing Address - Fax:858-622-0201
Practice Address - Street 1:5665 OBERLIN DR STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1739
Practice Address - Country:US
Practice Address - Phone:858-622-0221
Practice Address - Fax:858-622-0201
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical