Healthcare Provider Details

I. General information

NPI: 1326071564
Provider Name (Legal Business Name): JASNA B. MRDJEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14125 CAPRI DR STE 1A
LOS GATOS CA
95032-1500
US

IV. Provider business mailing address

14125 CAPRI DR STE 1A
LOS GATOS CA
95032-1500
US

V. Phone/Fax

Practice location:
  • Phone: 408-374-4423
  • Fax: 408-374-2619
Mailing address:
  • Phone: 408-374-4423
  • Fax: 408-374-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA31833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: