Provider Demographics
NPI:1619219946
Name:JAKSIC, MIRJANA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRJANA
Middle Name:
Last Name:JAKSIC
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 1:2085 CHANDELEUR DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6371
Mailing Address - Country:US
Mailing Address - Phone:310-519-7500
Mailing Address - Fax:310-831-8740
Practice Address - Street 1:2085 CHANDELEUR DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-6371
Practice Address - Country:US
Practice Address - Phone:310-519-7500
Practice Address - Fax:310-831-8740
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE29308208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics