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General NPI Number Information
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NPI Number | 1619102837
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Entity Type | Individual
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Provider Name | MLADEN JECMENICA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 2097 COMPTON AVE STE 103
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City | CORONA
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State | CA
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Zip | 92881-7289
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Country | US
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Telephone | 951-934-0505
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Fax | 951-934-0505
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Provider Business Mailing Address
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Address Line | 3943 IRVINE BLVD STE 40
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City | IRVINE
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State | CA
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Zip | 92602-2400
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Country | US
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Telephone | 951-934-0505
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Fax | 951-444-7749
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD449785
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD449785
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD449785
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License Number State | CA
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