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1093949703
DIVYA PANNALA
MODESTO, CA
NPI
1093949703
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: CA A116350)
Enumeration Date
2009-05-08
Last Update Date
2012-11-26
Business Address
-- DIVYA PANNALA M.D.
3612 DALE RD
MODESTO, CA 95356-0500
Phone number: 209-522-0146
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Mailing Address
-- DIVYA PANNALA M.D.
600 COFFEE RD
MODESTO, CA 95355-4201
Phone number: 209-521-6097
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