Healthcare Provider Details

I. General information

NPI: 1740497940
Provider Name (Legal Business Name): DIVYA MENEZES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 SW 172ND AVE SUITE 304
MIRAMAR FL
33029-5593
US

IV. Provider business mailing address

2201 S OCEAN DR #2203
HOLLYWOOD FL
33019-2539
US

V. Phone/Fax

Practice location:
  • Phone: 954-441-1144
  • Fax:
Mailing address:
  • Phone: 954-237-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME93852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: