Divine Health Medical and Spa LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

DIVINE HEALTH MEDICAL AND SPA LLC

Practice address

11119 Rockville Pike Ste 320
Rockville, MD 20852-3143

Phone

(240) 669-6598

Fax

(240) 669-6079

NPI assigned

Apr 19, 2022

Last updated

Jul 14, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sally Owie Young, FNPNPI 1568015634

Title

Educator

Phone

(240) 437-9997

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sally Owie Young

  • Family Nurse Practitioner
  • Washington, DC
  • NPI 1568015634
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1790428555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12406 BUCKLEY DR",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209042017",
            "telephone_number": "240-437-9997",
            "fax_number": "240-669-6079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11119 ROCKVILLE PIKE STE 320",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208523143",
            "telephone_number": "240-669-6598",
            "fax_number": "240-669-6079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE HEALTH MEDICAL AND SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-19",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "SALLY",
        "authorized_official_middle_name": "OWIE",
        "authorized_official_title_or_position": "EDUCATOR",
        "authorized_official_telephone_number": "240-437-9997",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana Liza Disla de Batista
• Marshall A. Dispenza, D.C.
• Evangelina Dispirito
• District Mobile Dental LLC
• Divine Care Services, LLC
• Sweta Diwan
• Kiran Dixit, LCPC
• Amber Dixon
• April Dixon
• Britny Dixon

• Primary Care Clinic/Center in Rockville, MD
• Providers in Rockville, MD by specialty
• Primary Care Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.