Healthcare Provider Details

I. General information

NPI: 1184184152
Provider Name (Legal Business Name): DIVYA CHADALAVADA KISHORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 ABBOTT ST
SALINAS CA
93901-4325
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-5200
  • Fax: 831-796-3891
Mailing address:
  • Phone: 831-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA203960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: