Provider Demographics
NPI:1043666423
Name:JANARDHANAN, DIVYA
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:JANARDHANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57781
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7781
Mailing Address - Country:US
Mailing Address - Phone:832-916-2075
Mailing Address - Fax:832-916-2480
Practice Address - Street 1:13009 GULF COMMERCE DR STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-1576
Practice Address - Country:US
Practice Address - Phone:832-916-2075
Practice Address - Fax:832-916-2480
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282313207L00000X
TXT0525207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine