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General NPI Number Information
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NPI Number | 1982140901
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Entity Type | Organization
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Legal Business Name | MINERVA MENTAL HEALTH P.C.
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 4448 AMBROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-2115
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Country | US
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Telephone | 323-644-1998
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Fax | 323-644-2600
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Provider Business Mailing Address
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Address Line | 4448 AMBROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-2115
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Country | US
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Telephone | 323-644-1998
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Fax | 323-644-2600
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MILICA STEFANOVIC
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Credential | M.D.
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Telephone | 323-644-1998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A91413
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License Number State | CA
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