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General NPI Number Information
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NPI Number | 1225612674
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Entity Type | Individual
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Provider Name | DJORDJE MILIVOJEVIC DO
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Gender | Male
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 02/23/2025
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Provider Practice Location Address
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Address Line | 1499 E HIGHLAND AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-4611
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Country | US
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Telephone | 855-422-8029
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1819
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Country | US
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Telephone | 909-580-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A21186
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License Number State | CA
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