Healthcare Provider Details

I. General information

NPI: 1154409035
Provider Name (Legal Business Name): SRETENKA DOKICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 PALM AVE
IMPERIAL BEACH CA
91932
US

IV. Provider business mailing address

PO BOX 459
IMPERIAL BEACH CA
91933
US

V. Phone/Fax

Practice location:
  • Phone: 619-429-3733
  • Fax:
Mailing address:
  • Phone: 619-429-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: