Individual
DIVYA MAMILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
900 23RD ST NW, WASHINGTON, DC 20037-2342
(313) 657-3970
Mailing address
900 23RD ST NW, WASHINGTON, DC 20037-2342
(202) 741-3000
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/13/2020
Last updated
07/15/2020
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