Provider Demographics
NPI:1386678845
Name:VUKICEVIC, JELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:JELENA
Middle Name:
Last Name:VUKICEVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WELCH RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1904
Mailing Address - Country:US
Mailing Address - Phone:650-329-0300
Mailing Address - Fax:650-329-8421
Practice Address - Street 1:1101 WELCH RD
Practice Address - Street 2:SUITE A1
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1904
Practice Address - Country:US
Practice Address - Phone:650-329-0300
Practice Address - Fax:650-329-8421
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48868208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics