Provider Demographics
NPI:1235159724
Name:DIVINAGRACIA, VILMA CONG (RN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:VILMA
Middle Name:CONG
Last Name:DIVINAGRACIA
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Gender:F
Credentials:RN, CNS
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Mailing Address - Street 1:VASDHS- ECC
Mailing Address - Street 2:3350 LA JOLLA VILLAGE DRIVE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0001
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:858-642-6255
Practice Address - Street 1:VASDHS- ECC
Practice Address - Street 2:3350 LA JOLLA VILLAGE DRIVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-642-6255
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-12
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Provider Licenses
StateLicense IDTaxonomies
CA343276163W00000X
CA1509364SC1501X
CA163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0600XNursing Service ProvidersRegistered NurseGerontology