Provider Demographics
NPI:1497818405
Name:WERNER, KRISTINE (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:WERNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:WERNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3857 BIRCH ST STE 605
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2616
Mailing Address - Country:US
Mailing Address - Phone:949-783-3600
Mailing Address - Fax:949-783-3602
Practice Address - Street 1:36101 BOB HOPE DR STE B2
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2003
Practice Address - Country:US
Practice Address - Phone:760-321-1315
Practice Address - Fax:760-321-1094
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10791103TC0700X, 208VP0014X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist