Individual
DIVYA KODURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2539 MEDICAL DR STE 105, ALAMOGORDO, NM 88310-8720
(508) 471-7499
Mailing address
2539 MEDICAL DR STE 105, ALAMOGORDO, NM 88310-8720
(508) 471-7499
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RS2022-0787
NM
390200000X
Student in an Organized Health Care Education/Training Program
RS2022-0787
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2022
Last updated
06/23/2022
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