Provider Demographics
NPI:1114021235
Name:VERNER, DIVINA ROSARIO SAN DIEGO (MD)
Entity Type:Individual
Prefix:DR
First Name:DIVINA ROSARIO
Middle Name:SAN DIEGO
Last Name:VERNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIVINA ROSARIO
Other - Middle Name:GASPAR
Other - Last Name:SAN DIEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:511 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-2153
Mailing Address - Country:US
Mailing Address - Phone:785-263-6684
Mailing Address - Fax:785-263-6803
Practice Address - Street 1:511 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-2153
Practice Address - Country:US
Practice Address - Phone:785-263-6684
Practice Address - Fax:785-263-6803
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74067208100000X
KS04-32289208100000X
OR150689208100000X
WA60130112208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation