Provider Demographics
NPI:1104411628
Name:DIVINE INFUSION
Entity type:Organization
Organization Name:DIVINE INFUSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:GIRISH
Authorized Official - Middle Name:HIMMATLAL
Authorized Official - Last Name:BHUNDIYA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-795-1522
Mailing Address - Street 1:801 E MOBECK ST APT 801B
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4700
Mailing Address - Country:US
Mailing Address - Phone:505-795-1522
Mailing Address - Fax:626-412-4414
Practice Address - Street 1:801 E MOBECK ST APT 801B
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4700
Practice Address - Country:US
Practice Address - Phone:505-795-1522
Practice Address - Fax:626-412-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty
No251F00000XAgenciesHome InfusionGroup - Single Specialty