Provider Demographics
NPI:1023351384
Name:DIVECHA, DIPAL KAUSHIK (PA-C)
Entity type:Individual
Prefix:
First Name:DIPAL
Middle Name:KAUSHIK
Last Name:DIVECHA
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16659 SOUTHWEST FWY
Mailing Address - Street 2:MOB 2, SUITE 461
Mailing Address - City:SUGARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:832-532-7514
Mailing Address - Fax:832-532-7801
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:MOB 2, SUITE 461
Practice Address - City:SUGARLAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:832-532-7514
Practice Address - Fax:832-532-7801
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08285363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA08285OtherMEDICAL LICENSE