Provider Demographics
NPI:1649889916
Name:DIVINE HEALTH INC
Entity type:Organization
Organization Name:DIVINE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JHURANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-703-9362
Mailing Address - Street 1:1098 PENSACOLA ST
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3531
Mailing Address - Country:US
Mailing Address - Phone:650-703-9362
Mailing Address - Fax:
Practice Address - Street 1:348 RHEEM BLVD
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-1516
Practice Address - Country:US
Practice Address - Phone:925-376-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty