Healthcare Provider Details

I. General information

NPI: 1508242215
Provider Name (Legal Business Name): DIVYA CHHABRA M.B.B.S,MMSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 TURN PIKE DR
FOLSOM CA
95630-8149
US

IV. Provider business mailing address

2516 STOCKTON BLVD
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 978-875-4262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number309891
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA128429
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberDR.0059739
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number309891
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberA128429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: