Healthcare Provider Details

I. General information

NPI: 1215480017
Provider Name (Legal Business Name): MILENA JANJIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 FAIRMONT DR
CASTRO VALLEY CA
94578-1001
US

IV. Provider business mailing address

2050 FAIRMONT DR
CASTRO VALLEY CA
94578-1001
US

V. Phone/Fax

Practice location:
  • Phone: 510-895-5502
  • Fax:
Mailing address:
  • Phone: 510-895-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number708439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: