Provider Demographics
NPI:1326071564
Name:MRDJEN, JASNA B (MD)
Entity Type:Individual
Prefix:DR
First Name:JASNA
Middle Name:B
Last Name:MRDJEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14125 CAPRI DR
Mailing Address - Street 2:STE 1A
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1500
Mailing Address - Country:US
Mailing Address - Phone:408-374-4423
Mailing Address - Fax:408-374-2619
Practice Address - Street 1:14125 CAPRI DR
Practice Address - Street 2:STE 1A
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1500
Practice Address - Country:US
Practice Address - Phone:408-374-4423
Practice Address - Fax:408-374-2619
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA31833208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A318330Medicaid
CAA26614Medicare UPIN
CA00A318330Medicaid
010044787Medicare PIN