Healthcare Provider Details

I. General information

NPI: 1821466574
Provider Name (Legal Business Name): GEORGE DAJKOVICH N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E HUNTINGTON DR STE 101
MONROVIA CA
91016-6423
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 626-358-0269
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95003100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: