Healthcare Provider Details

I. General information

NPI: 1194561886
Provider Name (Legal Business Name): KATARINA NEVENA VIDOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR STE 100
BEVERLY HILLS CA
90210-4308
US

IV. Provider business mailing address

39219 GUARDINO DR APT 163
FREMONT CA
94538-3015
US

V. Phone/Fax

Practice location:
  • Phone: 310-993-4679
  • Fax:
Mailing address:
  • Phone: 925-202-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: