Healthcare Provider Details

I. General information

NPI: 1285915728
Provider Name (Legal Business Name): MARIA ROMAN DJURIC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MARIA ROMAN BROOK

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROSECRANS ST STE 704
SAN DIEGO CA
92110
US

IV. Provider business mailing address

3851 ROSECRANS ST STE 704
SAN DIEGO CA
92110-3115
US

V. Phone/Fax

Practice location:
  • Phone: 619-542-4121
  • Fax: 619-692-5677
Mailing address:
  • Phone: 619-542-4121
  • Fax: 619-692-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number638379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: