Healthcare Provider Details

I. General information

NPI: 1346437258
Provider Name (Legal Business Name): IGOR JERCINOVICH, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E ELDER ST STE 105
FALLBROOK CA
92028-3082
US

IV. Provider business mailing address

521 E ELDER ST STE 105
FALLBROOK CA
92028-3082
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-5851
  • Fax: 760-728-0703
Mailing address:
  • Phone: 760-728-5851
  • Fax: 760-728-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: IGOR A JERCINOVICH
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 760-728-5851