Healthcare Provider Details

I. General information

NPI: 1477086122
Provider Name (Legal Business Name): DIVYA MANOHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8767 WILSHIRE BLVD # F2
BEVERLY HILLS CA
90211-2714
US

IV. Provider business mailing address

4140 W 190TH ST FL 2
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9481
  • Fax:
Mailing address:
  • Phone: 310-423-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA176136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: