MEDICARE: ILJA DEJANOVIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A202203	CA
2	207RI0011X	Interventional Cardiology Physician	A202203	CA

General Provider Information

NPI Number	:	1841796778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILJA DEJANOVIC

Provider Business Mailing Address
First Line	:	100 WILSON RD STE 100
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-7885
Country	:	US
Telephone Number	:	831-242-8645
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 SAN JOSE ST STE 301
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-3928
Country	:	US
Telephone Number	:	831-759-3289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2018
Last Update Date	:	04/28/2026

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Directions to “ ILJA DEJANOVIC ” Practice Location

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