Provider Demographics
NPI:1689041915
Name:NEZIRIC, SANJIN
Entity Type:Individual
Prefix:
First Name:SANJIN
Middle Name:
Last Name:NEZIRIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 S FINLEY RD APT 216
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4382
Mailing Address - Country:US
Mailing Address - Phone:630-290-8985
Mailing Address - Fax:
Practice Address - Street 1:1331 S FINLEY RD APT 216
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4382
Practice Address - Country:US
Practice Address - Phone:630-290-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker