Healthcare Provider Details

I. General information

NPI: 1619175445
Provider Name (Legal Business Name): DIVA S SEDDICK M.D., C.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/24/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 SAN RAMON VALLEY BLVD STE 220
DANVILLE CA
94526-4049
US

IV. Provider business mailing address

3641 COUNTRY CLUB TER
DANVILLE CA
94506-6064
US

V. Phone/Fax

Practice location:
  • Phone: 925-255-5411
  • Fax: 866-374-4490
Mailing address:
  • Phone: 925-785-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA62960
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA62960
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberA62960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: