Provider Demographics
NPI:1285921155
Name:PRABHU, DIVYA (MBBS)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:PRABHU
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 GRANT RD STE E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4344
Mailing Address - Country:US
Mailing Address - Phone:650-962-4370
Mailing Address - Fax:
Practice Address - Street 1:2660 GRANT RD STE E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-962-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV213932084N0400X
WAMD613532112084N0400X
FLTPME59432084N0400X
IN01086447A2084N0400X
CAA1379022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology