Healthcare Provider Details

I. General information

NPI: 1497818405
Provider Name (Legal Business Name): KRISTINE WERNER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRIS WERNER PHD

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36101 BOB HOPE DR STE B2
RANCHO MIRAGE CA
92270-2003
US

IV. Provider business mailing address

3857 BIRCH ST STE 605
NEWPORT BEACH CA
92660-2616
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-1315
  • Fax: 760-321-1094
Mailing address:
  • Phone: 949-783-3600
  • Fax: 949-783-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10791
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberPSY10791
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY10791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: