Healthcare Provider Details

I. General information

NPI: 1841796778
Provider Name (Legal Business Name): ILJA DEJANOVIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 SAN JOSE ST STE 301
SALINAS CA
93901-3928
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-759-3289
  • Fax:
Mailing address:
  • Phone: 831-242-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA202203
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA202203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: