Healthcare Provider Details

I. General information

NPI: 1922816628
Provider Name (Legal Business Name): MR. SASA MILOSEVIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10841 NOEL ST STE 110
LOS ALAMITOS CA
90720-6701
US

IV. Provider business mailing address

10841 NOEL ST STE 110
LOS ALAMITOS CA
90720-6701
US

V. Phone/Fax

Practice location:
  • Phone: 310-922-0936
  • Fax:
Mailing address:
  • Phone: 310-922-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License Number00351789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: