Provider Demographics
NPI:1528185949
Name:TASIC, KATARINA MINA (MD)
Entity Type:Individual
Prefix:
First Name:KATARINA
Middle Name:MINA
Last Name:TASIC
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 1:11705 ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4023
Mailing Address - Country:US
Mailing Address - Phone:323-568-4677
Mailing Address - Fax:323-568-4650
Practice Address - Street 1:11705 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4023
Practice Address - Country:US
Practice Address - Phone:323-568-4677
Practice Address - Fax:323-568-4650
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA671582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI24610Medicare ID - Type Unspecified