Healthcare Provider Details

I. General information

NPI: 1528648185
Provider Name (Legal Business Name): DIVYA MANIVANNAN DEV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E HERNDON AVE
FRESNO CA
93720-3306
US

IV. Provider business mailing address

428 MADERA AVE APT NO10
SUNNYVALE CA
94086-7447
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-3000
  • Fax:
Mailing address:
  • Phone: 650-382-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA191906
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA191906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: