Provider Demographics
NPI:1922381193
Name:AIYAR, DIVYA
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:AIYAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7787 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-2309
Mailing Address - Country:US
Mailing Address - Phone:916-722-1982
Mailing Address - Fax:916-722-6640
Practice Address - Street 1:7787 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2309
Practice Address - Country:US
Practice Address - Phone:916-722-1982
Practice Address - Fax:916-722-6640
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist