Provider Demographics
NPI:1699534198
Name:SOOD, DIVYANSHI (MBBS, MS)
Entity type:Individual
Prefix:
First Name:DIVYANSHI
Middle Name:
Last Name:SOOD
Suffix:
Gender:F
Credentials:MBBS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W 14TH ST # 81003
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2705
Mailing Address - Country:US
Mailing Address - Phone:719-595-7585
Mailing Address - Fax:
Practice Address - Street 1:311 W 14TH ST # 81003
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2705
Practice Address - Country:US
Practice Address - Phone:719-595-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program