Healthcare Provider Details

I. General information

NPI: 1689774325
Provider Name (Legal Business Name): DUNJA MILUTIN MAGLICA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23441 MADISON ST 305
TORRANCE CA
90505-4725
US

IV. Provider business mailing address

4020 VIA PAVION
PALOS VERDES ESTATES CA
90274-1457
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-5115
  • Fax: 310-378-9779
Mailing address:
  • Phone: 310-378-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA33543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: