Provider Demographics
NPI:1851402259
Name:KUNOVAC, JELENA (MD)
Entity Type:Individual
Prefix:
First Name:JELENA
Middle Name:
Last Name:KUNOVAC
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 1:3998 VISTA WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4514
Mailing Address - Country:US
Mailing Address - Phone:760-806-1800
Mailing Address - Fax:760-806-1801
Practice Address - Street 1:3012 W CHARLESTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1972
Practice Address - Country:US
Practice Address - Phone:702-527-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV137032084P0800X
AZ505122084P0800X
CAA661352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A66135AMedicaid
CAA66135AMedicare ID - Type Unspecified