Provider Demographics
NPI:1861953143
Name:DIVENE, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:DIVENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12188 HESPERIA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5822
Mailing Address - Country:US
Mailing Address - Phone:760-477-2199
Mailing Address - Fax:760-513-9690
Practice Address - Street 1:12188 HESPERIA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5822
Practice Address - Country:US
Practice Address - Phone:760-477-2199
Practice Address - Fax:760-513-9690
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator