Individual
DR. SURAJ DIVECHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
96 15TH ST. NE, SUITE 104, NORTON, VA 24273
(276) 679-7457
Mailing address
31662 ISLE ROYAL DR, LAGUNA NIGUEL, CA 92677-2824
(949) 516-8133
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0116038959
VA
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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