Healthcare Provider Details

I. General information

NPI: 1205883972
Provider Name (Legal Business Name): MONICA S DIVAKARUNI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 ADAMS ST STE 106
SAINT HELENA CA
94574-1168
US

IV. Provider business mailing address

999 ADAMS ST STE 106
SAINT HELENA CA
94574-1168
US

V. Phone/Fax

Practice location:
  • Phone: 707-963-4997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA87860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: