MEDICARE: MISS DIVYA SRINIVASAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1186711	TX

General Provider Information

NPI Number	:	1528728110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DIVYA SRINIVASAN

Provider Business Mailing Address
First Line	:	3623 W ALABAMA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5927
Country	:	US
Telephone Number	:	832-797-1739
Fax Number	:

Provider Business Practice Location Address
First Line	:	7077 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2505
Country	:	US
Telephone Number	:	713-333-7262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	12/29/2021

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Directions to “ MISS DIVYA SRINIVASAN ” Practice Location

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