Individual
DIVYA PRAMOD NIMMATOORI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18404 N TATUM BLVD STE 101, PHOENIX, AZ 85032-1511
(602) 992-1900
Mailing address
18404 N TATUM BLVD STE 101, PHOENIX, AZ 85032-1511
(602) 992-1900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
73916
AZ
Other
Enumeration date
01/06/2021
Last updated
08/20/2024
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