Healthcare Provider Details

I. General information

NPI: 1619102837
Provider Name (Legal Business Name): MLADEN JECMENICA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2097 COMPTON AVE STE 103
CORONA CA
92881-7289
US

IV. Provider business mailing address

3943 IRVINE BLVD STE 40
IRVINE CA
92602-2400
US

V. Phone/Fax

Practice location:
  • Phone: 951-934-0505
  • Fax: 951-934-0505
Mailing address:
  • Phone: 951-934-0505
  • Fax: 951-444-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD449785
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD449785
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD449785
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: