Active NPI
Kristina M Divico, DPT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1851633739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 39995
- Practice address
- 404 Camino del Rio S
Suite 508
San Diego, CA 92108-3503 - Phone
- (619) 325-0154
- NPI assigned
- Mar 19, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 39995 | CA | Primary |
Addresses
Primary practice location
404 Camino del Rio S
Suite 508
San Diego, CA 92108-3503
Mailing address
715 Cohasset CT
Apt 15
San Diego, CA 92109-8142
Phone (206) 661-1501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363651200000",
"number": "1851633739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "715 COHASSET CT",
"address_2": "APT 15",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921098142",
"telephone_number": "206-661-1501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 CAMINO DEL RIO S",
"address_2": "SUITE 508",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083503",
"telephone_number": "619-325-0154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIVICO",
"first_name": "KRISTINA",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-19",
"last_updated": "2013-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "39995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.