Individual
DR. DIVYA BACHARANIANDA MUTHAPPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
19260 STONE OAK PKWY STE 105, SAN ANTONIO, TX 78258
(210) 402-3456
(210) 402-3233
Mailing address
19260 STONE OAK PKWY, SUITE 105, SAN ANTONIO, TX 78258-3365
(210) 402-3456
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
P5692
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322793601
—
TX
Enumeration date
07/06/2009
Last updated
06/29/2018
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