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Individual

REZIA CATHERINE SHOBHANA DIVAKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
6551 N ORANGE BLOSSOM TRL, STE# 229, MOUNT DORA, FL 32757-7013
(352) 383-8384
Mailing address
13506 SUMMERPORT VILLAGE PKWY, STE# 334, WINDERMERE, FL 34786-7366
(352) 383-8384

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME96675
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
008731900
FL
01
56693
BCBS
FL
Enumeration date
09/28/2006
Last updated
08/15/2013
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