Provider Demographics
NPI:1497785208
Name:SESERINAC, JASNA (MD)
Entity Type:Individual
Prefix:MS
First Name:JASNA
Middle Name:
Last Name:SESERINAC
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 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-7124
Mailing Address - Country:US
Mailing Address - Phone:520-626-6614
Mailing Address - Fax:520-626-2883
Practice Address - Street 1:1501 N CAMPBELL AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724
Practice Address - Country:US
Practice Address - Phone:520-626-6614
Practice Address - Fax:520-626-2883
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-093075208000000X
AZ33299208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI181641Medicaid
H27067Medicare UPIN
AZZ 120364Medicare PIN