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NPI Code Detail

MEDICARE: RENATA SELAK STANKOVIC M.D.

MEDICARE: RENATA SELAK STANKOVIC M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianC54463CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023065620
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENATA SELAK STANKOVIC M.D.
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 19950 RINALDI ST STE 300
Second Line :
City : PORTER RANCH
State : CA
Zip : 91326-4141
Country : US
Telephone Number : 818-271-2400
Fax Number : 818-271-2401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 07/12/2019

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Directions to “ RENATA SELAK STANKOVIC M.D.” Practice Location

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