Most Relevant Information
Provider Data
| NPI Number: | 1003326885 |
| Provider Name: | DIVYA THEKKETHALA WINOVICH MPH |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/05/2017 |
| Last Updated: | 10/05/2017 |
Provider Practice Location
2121 SE BELMONT ST APT 122
PORTLAND
OR
972143394
Practice Location Phone/Fax
| Phone: | 7742660878 |
| Fax: |
Provider Mailing Location
2121 SE BELMONT ST APT 122
PORTLAND
OR
972143394
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |