Provider Demographics
NPI:1750428801
Name:JOSHI, DIVAKAR (DO)
Entity type:Individual
Prefix:
First Name:DIVAKAR
Middle Name:
Last Name:JOSHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:PSSB, SUITE 1200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-5630
Mailing Address - Fax:916-734-7980
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:PSSB, SUITE 1200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-5630
Practice Address - Fax:916-734-7980
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9704207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN