Healthcare Provider Details

I. General information

NPI: 1568160810
Provider Name (Legal Business Name): SELMA DJOKOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26222 ESCALA DR
MISSION VIEJO CA
92691-4817
US

IV. Provider business mailing address

26222 ESCALA DR
MISSION VIEJO CA
92691-4817
US

V. Phone/Fax

Practice location:
  • Phone: 949-315-0653
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: