Healthcare Provider Details

I. General information

NPI: 1023063427
Provider Name (Legal Business Name): SONAL A DIVECHA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E MEDICAL CENTER BLVD
WEBSTER TX
77598-4376
US

IV. Provider business mailing address

205 E MEDICAL CENTER BLVD
WEBSTER TX
77598-4376
US

V. Phone/Fax

Practice location:
  • Phone: 281-480-7832
  • Fax: 281-480-7504
Mailing address:
  • Phone: 281-480-7832
  • Fax: 281-480-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM3521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: